Provider Demographics
NPI:1447471016
Name:BURCH, OLIVIA BOYLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:BOYLE
Last Name:BURCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:SUSAN
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1001 MATTHEW LN
Mailing Address - Street 2:APT. 206
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6638
Mailing Address - Country:US
Mailing Address - Phone:401-487-0562
Mailing Address - Fax:
Practice Address - Street 1:482 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-380-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist