Provider Demographics
NPI:1528564119
Name:BUREK, MICHELLE ANN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:BUREK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:BUREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1945 RAVENCROFT LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6348
Mailing Address - Country:US
Mailing Address - Phone:216-533-3178
Mailing Address - Fax:
Practice Address - Street 1:7000 W TANNERS CREEK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-1151
Practice Address - Country:US
Practice Address - Phone:757-852-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist