Provider Demographics
NPI:1669874301
Name:BURTRAW, ERIK R (COTA)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:R
Last Name:BURTRAW
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 E WIND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WIND LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1526
Mailing Address - Country:US
Mailing Address - Phone:262-949-2359
Mailing Address - Fax:
Practice Address - Street 1:8122 E WIND LAKE RD
Practice Address - Street 2:
Practice Address - City:WIND LAKE
Practice Address - State:WI
Practice Address - Zip Code:53185-1526
Practice Address - Country:US
Practice Address - Phone:262-949-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant