Provider Demographics
NPI:1336439611
Name:BURKE, CYNTHIA R (OTR)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:BURKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:R
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:3385 HONEYBURYL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4782
Mailing Address - Country:US
Mailing Address - Phone:719-548-7401
Mailing Address - Fax:
Practice Address - Street 1:3385 HONEYBURYL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4782
Practice Address - Country:US
Practice Address - Phone:719-548-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2253225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2253OtherSTATE LICENSE