Provider Demographics
NPI:1124187380
Name:BURMEISTER, SONJA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:BURMEISTER
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 1:551 E STATION AVE
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2027
Mailing Address - Country:US
Mailing Address - Phone:484-863-9220
Mailing Address - Fax:484-353-5157
Practice Address - Street 1:551 E STATION AVE
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2027
Practice Address - Country:US
Practice Address - Phone:484-863-9220
Practice Address - Fax:484-353-5157
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051162363A00000X
PAO006640L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32147Medicare UPIN