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NPI Code Detail

MEDICARE: ERIC S BURBACK OT

MEDICARE: ERIC S BURBACK OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT461ID
2225XH1200XHand Occupational TherapistOT-461ID

General Provider Information

NPI Number : 1053480236
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC S BURBACK OT
Provider Business Mailing Address
First Line : 901 N CURTIS RD STE 304
Second Line :
City : BOISE
State : ID
Zip : 83706-1341
Country : US
Telephone Number : 208-342-4263
Fax Number : 208-375-0597
Provider Business Practice Location Address
First Line : 901 N CURTIS RD STE 304
Second Line :
City : BOISE
State : ID
Zip : 83706-1341
Country : US
Telephone Number : 208-342-4263
Fax Number : 208-375-0597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 06/05/2020

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Directions to “ ERIC S BURBACK OT” Practice Location

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