Provider Demographics
NPI:1235917519
Name:BURKS, PATRICIA CAMPBELL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:CAMPBELL
Last Name:BURKS
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 1:1537 JUDY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-6403
Mailing Address - Country:US
Mailing Address - Phone:706-415-6771
Mailing Address - Fax:
Practice Address - Street 1:10 W GROVE AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4516
Practice Address - Country:US
Practice Address - Phone:706-415-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002566225X00000X
FLOT23034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist