Provider Demographics
NPI:1952587123
Name:BURKS, DEIDRA KAY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:KAY
Last Name:BURKS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:JEWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66949
Mailing Address - Country:US
Mailing Address - Phone:785-428-3292
Mailing Address - Fax:
Practice Address - Street 1:815 N INDEPENDENCE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420
Practice Address - Country:US
Practice Address - Phone:785-738-9907
Practice Address - Fax:785-738-9909
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist