MEDICARE: MRS. ZOE ALISON BURCH MA

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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	IMF 53057	CA

General Provider Information

NPI Number	:	1073706602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ZOE ALISON BURCH MA

Provider Business Mailing Address
First Line	:	15 E PLEASANT ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-2201
Country	:	US
Telephone Number	:	937-325-5564
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 E PLEASANT ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-2201
Country	:	US
Telephone Number	:	937-325-5564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	02/08/2012

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