Provider Demographics
NPI:1184352924
Name:BURKE, TEDA PATRICE (COTA)
Entity type:Individual
Prefix:MISS
First Name:TEDA
Middle Name:PATRICE
Last Name:BURKE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ONTARIO PL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3731
Mailing Address - Country:US
Mailing Address - Phone:561-619-1913
Mailing Address - Fax:
Practice Address - Street 1:401 ONTARIO PL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3731
Practice Address - Country:US
Practice Address - Phone:561-619-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6165224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant