Provider Demographics
NPI:1831317049
Name:SUNBURST THERAPY,LLC
Entity type:Organization
Organization Name:SUNBURST THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTRL
Authorized Official - Prefix:
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-324-0542
Mailing Address - Street 1:380 CANYONVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8630
Mailing Address - Country:US
Mailing Address - Phone:505-324-0542
Mailing Address - Fax:505-324-0542
Practice Address - Street 1:380 CANYONVIEW DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8630
Practice Address - Country:US
Practice Address - Phone:505-324-0542
Practice Address - Fax:505-324-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty