Provider Demographics
NPI:1467134106
Name:BURCKHARD, MICHAYLA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAYLA
Middle Name:ANN
Last Name:BURCKHARD
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 1:1311 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5406
Mailing Address - Country:US
Mailing Address - Phone:701-317-2897
Mailing Address - Fax:701-213-4345
Practice Address - Street 1:3535 S 31ST ST STE 105
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3592
Practice Address - Country:US
Practice Address - Phone:701-317-2897
Practice Address - Fax:701-213-4345
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2032OtherOT LICENSE NUMBER