Provider Demographics
NPI:1053865295
Name:BURMARK, BLAIR (OTR/L)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:BURMARK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:WALKIEWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1850 BOYER AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2922
Mailing Address - Country:US
Mailing Address - Phone:206-325-8477
Mailing Address - Fax:206-323-1385
Practice Address - Street 1:1850 BOYER AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-2922
Practice Address - Country:US
Practice Address - Phone:206-325-8477
Practice Address - Fax:206-323-1385
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60680320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7020464Medicaid