Provider Demographics
NPI:1477565935
Name:BURGESON, VAUGHN ANDREW (ORT/L)
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:ANDREW
Last Name:BURGESON
Suffix:
Gender:M
Credentials:ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1326
Mailing Address - Country:US
Mailing Address - Phone:419-537-0764
Mailing Address - Fax:419-537-0948
Practice Address - Street 1:3234 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1398
Practice Address - Country:US
Practice Address - Phone:419-536-8030
Practice Address - Fax:419-536-8073
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT02262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist