MEDICARE: MS. TONI MARIIA BURROUGHS

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1467637694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONI MARIIA BURROUGHS

Provider Business Mailing Address
First Line	:	5405 HARVEST LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3140
Country	:	US
Telephone Number	:	512-733-3869
Fax Number	:	512-916-1601

Provider Business Practice Location Address
First Line	:	5405 HARVEST LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3140
Country	:	US
Telephone Number	:	512-733-3869
Fax Number	:	512-916-1601

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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