Provider Demographics
NPI:1912934134
Name:BURK, BRENDA K
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:K
Last Name:BURK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:K
Other - Last Name:ROWLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 FADE AWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:479-238-3698
Mailing Address - Fax:
Practice Address - Street 1:3660 SOUTH NATIONAL AVE
Practice Address - Street 2:OXFORD HEALTHCARE
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65808-0939
Practice Address - Country:US
Practice Address - Phone:417-883-7552
Practice Address - Fax:417-841-2854
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 1605225X00000X
OK1091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W405Medicare ID - Type Unspecified