Provider Demographics
NPI:1265453864
Name:BURNS, BRIAN K (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:BURNS
Suffix:
Gender:M
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:RR # 2 BOX 294 A3
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:PA
Mailing Address - Zip Code:18465
Mailing Address - Country:US
Mailing Address - Phone:570-727-3339
Mailing Address - Fax:
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0030
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004977L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist