Provider Demographics
NPI:1528477338
Name:BURLA, ANGELA (MA, OTR/L, MT-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BURLA
Suffix:
Gender:F
Credentials:MA, OTR/L, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-2334
Mailing Address - Country:US
Mailing Address - Phone:906-364-5941
Mailing Address - Fax:
Practice Address - Street 1:202 ELM ST
Practice Address - Street 2:
Practice Address - City:BERGLAND
Practice Address - State:MI
Practice Address - Zip Code:49910-9604
Practice Address - Country:US
Practice Address - Phone:906-575-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11051225A00000X
11051225A00000X
MN106088225XP0200X
MI5201010998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty