Provider Demographics
NPI:1841543774
Name:BURRILL, SHAHRZAD ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:ANN
Last Name:BURRILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:BURRILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1209 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3907
Mailing Address - Country:US
Mailing Address - Phone:509-354-7951
Mailing Address - Fax:
Practice Address - Street 1:200 N BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0206
Practice Address - Country:US
Practice Address - Phone:509-354-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00003133OtherOCCUPATIONAL THERAPIST