Provider Demographics
NPI:1407098932
Name:BURTON, LISA A (OTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BURTON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19545 SUNFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66021-9776
Mailing Address - Country:US
Mailing Address - Phone:615-896-6400
Mailing Address - Fax:
Practice Address - Street 1:304 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66092-7800
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800451224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant