Provider Demographics
NPI:1417142274
Name:BURTON, JULIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 S 43RD RD
Mailing Address - Street 2:
Mailing Address - City:FAIR PLAY
Mailing Address - State:MO
Mailing Address - Zip Code:65649-9307
Mailing Address - Country:US
Mailing Address - Phone:417-654-8042
Mailing Address - Fax:
Practice Address - Street 1:400 BROAD ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-1405
Practice Address - Country:US
Practice Address - Phone:417-637-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005140224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant