Provider Demographics
NPI:1851007207
Name:BURT, MICHELLE (AMSA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:AMSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 RICHARDS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKLAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49234-9639
Mailing Address - Country:US
Mailing Address - Phone:517-769-4676
Mailing Address - Fax:
Practice Address - Street 1:1700 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:CLARKLAKE
Practice Address - State:MI
Practice Address - Zip Code:49234-9639
Practice Address - Country:US
Practice Address - Phone:517-769-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter