MEDICARE: BURCHETT ENTERPRISES LTD

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	602808055	WA
2	225100000X	Physical Therapist	602808055	WA

General Provider Information

NPI Number	:	1902296858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURCHETT ENTERPRISES LTD

Provider Business Mailing Address
First Line	:	12012 E MISSION AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4887
Country	:	US
Telephone Number	:	509-413-1630
Fax Number	:	509-413-1673

Provider Business Practice Location Address
First Line	:	12012 E MISSION AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4887
Country	:	US
Telephone Number	:	509-413-1630
Fax Number	:	509-413-1673

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUNA DENISE BURCHETT
Credential	:	OTR/L
Telephone Number	:	509-413-1630

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	01/30/2015

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