MEDICARE: KATHLEEN ANNE BURCH M.A., CCC-A

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	231H00000X	Audiologist	001460-1	NY

General Provider Information

NPI Number	:	1891891578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANNE BURCH M.A., CCC-A

Provider Business Mailing Address
First Line	:	98 N 2ND ST STE 103
Second Line	:
City	:	FULTON
State	:	NY
Zip	:	13069-1254
Country	:	US
Telephone Number	:	315-349-5828
Fax Number	:	315-349-5921

Provider Business Practice Location Address
First Line	:	98 N 2ND ST STE 103
Second Line	:
City	:	FULTON
State	:	NY
Zip	:	13069-1254
Country	:	US
Telephone Number	:	315-464-4806
Fax Number	:	315-464-5321

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/09/2020

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