Individual
NICOLE RAE BURKHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1850 W MATADOR ST, PERU, IN 46970-3711
(765) 689-5000
Mailing address
5110 E 1000 N, DECATUR, IN 46733-8152
(260) 515-7126
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001352A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32001352A
OCCUPATIONAL THERAPY ASSISTANT
IN
Enumeration date
04/19/2010
Last updated
04/19/2010
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