Provider Demographics
NPI:1477525293
Name:BURKE, MICHELE L (OT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:BURKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:CARPENTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 NOYES RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3843
Mailing Address - Country:US
Mailing Address - Phone:203-292-5961
Mailing Address - Fax:
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:914-787-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001772225X00000X
NY005936225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT130001772CT02OtherANTHEM BCBS
CT3565838OtherAETNA