Active NPI
Suzanne Michele Burbank, OTR/L, CLT
- Occupational Therapist
- Melbourne, FL
National Provider Identifier
1508409129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 14748
- Practice address
- 405 N Wickham Rd Ste 103
Melbourne, FL 32935-8628 - Phone
- (321) 327-8509
- NPI assigned
- Oct 27, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4427 | CT | |
| Occupational Therapist | 225X00000X | 14748 | FL | Primary |
Addresses
Primary practice location
405 N Wickham Rd Ste 103
Melbourne, FL 32935-8628
Mailing address
405 N Wickham Rd Ste 103
Melbourne, FL 32935-8628
Phone (239) 822-8846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14748 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572134400000",
"number": "1508409129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 N WICKHAM RD STE 103",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329358628",
"telephone_number": "239-822-8846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 N WICKHAM RD STE 103",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329358628",
"telephone_number": "321-327-8509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURBANK",
"first_name": "SUZANNE",
"middle_name": "MICHELE",
"credential": "OTR/L, CLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-27",
"last_updated": "2019-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CT",
"license": "4427",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "14748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.