Provider Demographics
NPI:1548567936
Name:BURKUM, PAIGE M (OT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:BURKUM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:M
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7686 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1717
Mailing Address - Country:US
Mailing Address - Phone:402-578-3146
Mailing Address - Fax:
Practice Address - Street 1:7686 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1717
Practice Address - Country:US
Practice Address - Phone:402-578-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477702Medicaid