Provider Demographics
NPI:1801031299
Name:CHANDLER, BURKE (MA)
Entity Type:Individual
Prefix:MR
First Name:BURKE
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S COMMERCE ST
Mailing Address - Street 2:CLUSTER BOX 3
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3937
Mailing Address - Country:US
Mailing Address - Phone:580-223-3810
Mailing Address - Fax:580-223-5688
Practice Address - Street 1:5 S COMMERCE ST
Practice Address - Street 2:CLUSTER BOX 3
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3937
Practice Address - Country:US
Practice Address - Phone:580-223-3810
Practice Address - Fax:580-223-5688
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32231H00000X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier