Provider Demographics
NPI:1942456363
Name:BURKE, VALEN MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:VALEN
Middle Name:MARIE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 NE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3701
Mailing Address - Country:US
Mailing Address - Phone:352-208-8613
Mailing Address - Fax:
Practice Address - Street 1:2045 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6952
Practice Address - Country:US
Practice Address - Phone:352-208-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist