1386991990 NPI number — MRS. SUSAN LYNETTE BURGESS OCCUPATIONAL THERAPI

Table of content: MRS. SUSAN LYNETTE BURGESS OCCUPATIONAL THERAPI (NPI 1386991990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386991990 NPI number — MRS. SUSAN LYNETTE BURGESS OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGESS
Provider First Name:
SUSAN
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LYNETTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OCCUPATIONAL THERAPI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386991990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 PROVIDENCE LANE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-493-4995
Provider Business Mailing Address Fax Number:
360-493-4470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 PROVIDENCE LANE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-493-4995
Provider Business Practice Location Address Fax Number:
360-493-4470
Provider Enumeration Date:
08/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT00001922 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com