Provider Demographics
NPI:1689023459
Name:BURKE, CARMELLA ANN (OTR)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N 85TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2845
Mailing Address - Country:US
Mailing Address - Phone:414-405-4575
Mailing Address - Fax:
Practice Address - Street 1:2021 N 85TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-2845
Practice Address - Country:US
Practice Address - Phone:414-405-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2167-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist