Provider Demographics
NPI:1225178254
Name:BURTON, STEPHANIE HELEN (OTR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HELEN
Last Name:BURTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3216
Mailing Address - Country:US
Mailing Address - Phone:660-263-6994
Mailing Address - Fax:660-263-6940
Practice Address - Street 1:309 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3216
Practice Address - Country:US
Practice Address - Phone:660-263-6994
Practice Address - Fax:660-263-6940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist