Provider Demographics
NPI:1689804783
Name:BURT, ANGELA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:BURT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 BLUE JAY WAY
Mailing Address - Street 2:#203
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2414
Mailing Address - Country:US
Mailing Address - Phone:651-686-5256
Mailing Address - Fax:
Practice Address - Street 1:815 FOREST AVE.
Practice Address - Street 2:THREE LINKS CARE CENTER
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-664-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1027358225X00000X
MO2000160909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist