Provider Demographics
NPI:1093352692
Name:BURRIS, KALIYAH L (OTR/L)
Entity Type:Individual
Prefix:
First Name:KALIYAH
Middle Name:L
Last Name:BURRIS
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 1:103 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4524
Mailing Address - Country:US
Mailing Address - Phone:914-392-1140
Mailing Address - Fax:
Practice Address - Street 1:7 DEMPSEY PL
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-4427
Practice Address - Country:US
Practice Address - Phone:914-392-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024303225X00000X
NY24303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist