Provider Demographics
NPI:1952532756
Name:BURGOS, FLORELYN OLAVIDEZ
Entity type:Individual
Prefix:
First Name:FLORELYN
Middle Name:OLAVIDEZ
Last Name:BURGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 JACKSTAFF DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1171
Mailing Address - Country:US
Mailing Address - Phone:201-936-2414
Mailing Address - Fax:
Practice Address - Street 1:6229 JACKSTAFF DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1171
Practice Address - Country:US
Practice Address - Phone:201-936-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00468400225X00000X
TX117959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist