Provider Demographics
NPI:1427397389
Name:BURCHATZ, VICKIE LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:BURCHATZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:VICKIE
Other - Middle Name:LYNN
Other - Last Name:BERENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 FOURTH AVENUE NE
Mailing Address - Street 2:GOLDEN LIVING CENTER
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201
Mailing Address - Country:US
Mailing Address - Phone:605-886-8431
Mailing Address - Fax:605-753-7801
Practice Address - Street 1:415 FOURTH AVENUE NE
Practice Address - Street 2:GOLDEN LIVING CENTER
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201
Practice Address - Country:US
Practice Address - Phone:605-886-8431
Practice Address - Fax:605-753-7801
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD147A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant