MEDICARE: MARIETTE BURGER MHS, OTR/L

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	225XP0200X	Pediatric Occupational Therapist	OT04840	FL

General Provider Information

NPI Number	:	1861644403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIETTE BURGER MHS, OTR/L

Provider Business Mailing Address
First Line	:	4026 CRESCENT RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-5306
Country	:	US
Telephone Number	:	443-850-7773
Fax Number	:

Provider Business Practice Location Address
First Line	:	4026 CRESCENT RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-5306
Country	:	US
Telephone Number	:	443-850-7773
Fax Number	:

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	01/11/2013

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