Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 03-189454 | CT |
NPI | 1003936667 |
---|---|
Provider Name | Mrs. Catherine Burcham |
First Address | Alexandria, VA 22308-2132 |
Second Address | Alexandria, VA 22307-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |