Provider Demographics
NPI:1043752504
Name:BURR, MACY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:BURR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S CHAPARRAL CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2239
Mailing Address - Country:US
Mailing Address - Phone:206-240-8451
Mailing Address - Fax:
Practice Address - Street 1:140 S CHAPARRAL CT
Practice Address - Street 2:SUITE 150
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2239
Practice Address - Country:US
Practice Address - Phone:206-240-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist