MEDICARE: ROBIN BURST

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	225X00000X	Occupational Therapist	OT10119	FL

General Provider Information

NPI Number	:	1407047616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN BURST

Provider Business Mailing Address
First Line	:	4799 NW 92ND TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-1963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4799 NW 92ND TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-1963
Country	:	US
Telephone Number	:	361-368-1033
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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Directions to “ ROBIN BURST ” Practice Location

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