Provider Demographics
NPI:1518372218
Name:BURKE, SHARON KAYLENE (OTDR/L, CLT)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:KAYLENE
Last Name:BURKE
Suffix:
Gender:F
Credentials:OTDR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8346
Mailing Address - Country:US
Mailing Address - Phone:641-990-9685
Mailing Address - Fax:
Practice Address - Street 1:3521 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-8346
Practice Address - Country:US
Practice Address - Phone:641-990-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist