Provider Demographics
NPI:1083917264
Name:BURDETTE, RITA PRICE (OT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:PRICE
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 GALWAY ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3002
Mailing Address - Country:US
Mailing Address - Phone:540-522-3197
Mailing Address - Fax:
Practice Address - Street 1:325 GALWAY ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3002
Practice Address - Country:US
Practice Address - Phone:540-522-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000400224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant