Provider Demographics
NPI:1033725791
Name:BURKE, SKYLLAR (MOT, LOTR)
Entity Type:Individual
Prefix:
First Name:SKYLLAR
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 SUGAR OAKS RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-0095
Mailing Address - Country:US
Mailing Address - Phone:337-321-1379
Mailing Address - Fax:
Practice Address - Street 1:132 DEMANADE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2508
Practice Address - Country:US
Practice Address - Phone:337-534-8978
Practice Address - Fax:337-284-3040
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324296225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics