Provider Demographics
NPI:1528036183
Name:BURKARDT, SUZANNE SCHMOLL (CHT/OT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:SCHMOLL
Last Name:BURKARDT
Suffix:
Gender:F
Credentials:CHT/OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-9710
Mailing Address - Country:US
Mailing Address - Phone:610-407-0204
Mailing Address - Fax:
Practice Address - Street 1:1459 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-9710
Practice Address - Country:US
Practice Address - Phone:610-407-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001538L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0123789000OtherIBC
PA3837010OtherAETNA
PA11443178OtherCAQH