Provider Demographics
NPI:1285216192
Name:BURK, JEANETTE E (COTA,L)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:E
Last Name:BURK
Suffix:
Gender:F
Credentials:COTA,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 QUINLAN CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3816
Mailing Address - Country:US
Mailing Address - Phone:719-323-8082
Mailing Address - Fax:
Practice Address - Street 1:1245 QUINLAN CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3816
Practice Address - Country:US
Practice Address - Phone:719-323-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001409224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant