Provider Demographics
NPI:1225178338
Name:BURBACH, JULIE B (OT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:BURBACH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:B
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 KELLER AVE N
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1036
Mailing Address - Country:US
Mailing Address - Phone:715-268-1001
Mailing Address - Fax:715-268-1002
Practice Address - Street 1:220 KELLER AVE N
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1036
Practice Address - Country:US
Practice Address - Phone:715-268-1001
Practice Address - Fax:715-268-1002
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2870OtherSTATE LICENSE