Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2141 | CA |
NPI | 1033121694 |
---|---|
Provider Name | Ms. Teri Ellen Burgess |
First Address | Los Angeles, CA 90049-4663 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |