Individual
CLYDE EDWARD BURROUGHS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
15291 NW 60TH AVE STE 101, MIAMI LAKES, FL 33014-2459
(305) 705-7702
Mailing address
15291 NW 60TH AVE STE 101, MIAMI LAKES, FL 33014-2459
(305) 705-7702
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
23071
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23071
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
04/17/2022
Last updated
04/17/2022
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