Provider Demographics
NPI:1508965054
Name:BURNS, SUSAN BRUNO
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BRUNO
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BRUNO
Other - Last Name:DESTEFANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL CHT
Mailing Address - Street 1:10189 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322
Mailing Address - Country:US
Mailing Address - Phone:954-236-6770
Mailing Address - Fax:954-236-6771
Practice Address - Street 1:10189 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-236-6770
Practice Address - Fax:954-236-6771
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0000761225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2344Medicare ID - Type Unspecified