Provider Demographics
NPI:1174832406
Name:BURGESS, DARNELL VOGT (OT)
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:VOGT
Last Name:BURGESS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DARNELL
Other - Middle Name:VOGT
Other - Last Name:BABIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:120 WHITE ROSE DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2644
Practice Address - Country:US
Practice Address - Phone:985-532-9662
Practice Address - Fax:985-532-3942
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11134225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist