Provider Demographics
NPI:1386053478
Name:BURTON, SHOMARI (OTR-L)
Entity type:Individual
Prefix:
First Name:SHOMARI
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2105
Mailing Address - Country:US
Mailing Address - Phone:312-771-9631
Mailing Address - Fax:
Practice Address - Street 1:5125 CAROL ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2105
Practice Address - Country:US
Practice Address - Phone:312-771-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist