Provider Demographics
NPI:1720367253
Name:BURTON, COLLEEN BRITTANY
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:BRITTANY
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17485 TARAMINO PL
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6243
Mailing Address - Country:US
Mailing Address - Phone:305-519-5016
Mailing Address - Fax:
Practice Address - Street 1:17485 TARAMINO PL
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6243
Practice Address - Country:US
Practice Address - Phone:305-519-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001294225X00000X
PAOC011279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist