Provider Demographics
NPI:1003936667
Name:BURCHAM, CATHERINE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:BURCHAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 CULPEPER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-2132
Mailing Address - Country:US
Mailing Address - Phone:703-799-7459
Mailing Address - Fax:
Practice Address - Street 1:7116 FORT HUNT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1900
Practice Address - Country:US
Practice Address - Phone:703-780-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-189454224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant