Provider Demographics
NPI:1225290398
Name:BURCH, ALLISON DINIUS (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:DINIUS
Last Name:BURCH
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 1:38 BELLE GATE CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9678
Mailing Address - Country:US
Mailing Address - Phone:843-408-2461
Mailing Address - Fax:
Practice Address - Street 1:38 BELLE GATE CT
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9678
Practice Address - Country:US
Practice Address - Phone:843-408-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5967225X00000X
SC3122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist