Provider Demographics
NPI:1003336678
Name:BURBINE, THERESA
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:BURBINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5 N MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2317
Mailing Address - Country:US
Mailing Address - Phone:508-359-4532
Mailing Address - Fax:508-359-0198
Practice Address - Street 1:30 MAN MAR DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2271
Practice Address - Country:US
Practice Address - Phone:508-695-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist