Provider Demographics
NPI:1972828721
Name:BUERGER, PAUL MICHAEL (OTR)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:BUERGER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131268
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-1268
Mailing Address - Country:US
Mailing Address - Phone:903-534-9590
Mailing Address - Fax:903-534-5246
Practice Address - Street 1:1015 N MAIN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:TX
Practice Address - Zip Code:76665-4632
Practice Address - Country:US
Practice Address - Phone:903-534-9590
Practice Address - Fax:903-534-5246
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD10440808Medicaid