Provider Demographics
NPI:1881080554
Name:BURKS, ESPERANZA (OTRL)
Entity type:Individual
Prefix:MRS
First Name:ESPERANZA
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12684 NW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5124
Mailing Address - Country:US
Mailing Address - Phone:786-208-9195
Mailing Address - Fax:
Practice Address - Street 1:2833 EXECUTIVE PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3646
Practice Address - Country:US
Practice Address - Phone:954-353-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16961225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics