Provider Demographics
NPI:1003853334
Name:BURT, REBECCA L (MA, CCC/SLP, NBCT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:BURT
Suffix:
Gender:F
Credentials:MA, CCC/SLP, NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12242 MEDAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9563
Mailing Address - Country:US
Mailing Address - Phone:407-267-3205
Mailing Address - Fax:
Practice Address - Street 1:2000 DERBY GLEN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8025
Practice Address - Country:US
Practice Address - Phone:407-641-0808
Practice Address - Fax:407-812-4358
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6431235Z00000X
FLSA 6431222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist