Provider Demographics
NPI:1356768212
Name:BURWELL, EMILY
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:BURWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N VERNON ST
Mailing Address - Street 2:PO BOX 251
Mailing Address - City:MARINE
Mailing Address - State:IL
Mailing Address - Zip Code:62061-1082
Mailing Address - Country:US
Mailing Address - Phone:217-358-0030
Mailing Address - Fax:
Practice Address - Street 1:310 N VERNON ST
Practice Address - Street 2:
Practice Address - City:MARINE
Practice Address - State:IL
Practice Address - Zip Code:62061-1082
Practice Address - Country:US
Practice Address - Phone:217-358-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist