Provider Demographics
NPI:1780035576
Name:BURKE, BRIANNE MARY
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:MARY
Last Name:BURKE
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 1:26 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2413
Mailing Address - Country:US
Mailing Address - Phone:518-391-5335
Mailing Address - Fax:
Practice Address - Street 1:171 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:GREEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:12183-1212
Practice Address - Country:US
Practice Address - Phone:518-273-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist