Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 324296 | LA |
NPI | 1033725791 |
---|---|
Provider Name | Skyllar Burke |
First Address | New Iberia, LA 70563-0095 |
Second Address | Lafayette, LA 70503-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2020 |
Last Update Date | 18/09/2020 |