Provider Demographics
NPI:1417571464
Name:BURGASON, JESSICA (ATC/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:BURGASON
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24173 STATE HIGHWAY F
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-8009
Mailing Address - Country:US
Mailing Address - Phone:563-506-4246
Mailing Address - Fax:
Practice Address - Street 1:24173 STATE HIGHWAY F
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-8009
Practice Address - Country:US
Practice Address - Phone:563-506-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty