Provider Demographics
NPI:1093447799
Name:BURGESS, JOSEPH SCOTT (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SCOTT
Last Name:BURGESS
Suffix:
Gender:M
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 1:1435 CHROME HILL RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1635
Mailing Address - Country:US
Mailing Address - Phone:443-910-6190
Mailing Address - Fax:
Practice Address - Street 1:8530 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4334
Practice Address - Country:US
Practice Address - Phone:410-774-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09689225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics