Provider Demographics
NPI:1467667766
Name:BURTNETT, MARY ALICE K (OTR)
Entity Type:Individual
Prefix:
First Name:MARY ALICE
Middle Name:K
Last Name:BURTNETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421114
Mailing Address - Street 2:
Mailing Address - City:FLINTON
Mailing Address - State:PA
Mailing Address - Zip Code:16640-1114
Mailing Address - Country:US
Mailing Address - Phone:814-341-1126
Mailing Address - Fax:
Practice Address - Street 1:345 VO TECH DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904
Practice Address - Country:US
Practice Address - Phone:814-266-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005814L225X00000X
MD04421225X00000X
VA0119003255225X00000X
TN0000002966225X00000X
GAOT003788225X00000X
TX111416225X00000X
NV0650225X00000X
AZ3822225X00000X
CAOT9254225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist