Provider Demographics
NPI:1043468911
Name:BURBANK, KIMBERLY T (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:T
Last Name:BURBANK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 HORACE CT
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4810
Mailing Address - Country:US
Mailing Address - Phone:917-670-1825
Mailing Address - Fax:
Practice Address - Street 1:2476 HORACE CT
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4810
Practice Address - Country:US
Practice Address - Phone:917-670-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014566225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist