Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.200107 | LA |
NPI | 1013310424 |
---|---|
Provider Name | Miss Kristi Burgess |
First Address | Beaumont, TX 77707-2549 |
Second Address | Beaumont, TX 77707-2549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 29/09/2014 |