Provider Demographics
NPI:1104160654
Name:BURIAN, GARY LEONARD (OTA/L)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEONARD
Last Name:BURIAN
Suffix:
Gender:M
Credentials:OTA/L
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:LEONARD
Other - Last Name:BURIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTA/L
Mailing Address - Street 1:255 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-1572
Mailing Address - Country:US
Mailing Address - Phone:304-455-2600
Mailing Address - Fax:304-455-2580
Practice Address - Street 1:255 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1572
Practice Address - Country:US
Practice Address - Phone:304-455-2600
Practice Address - Fax:304-455-2580
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1021224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant