Provider Demographics
NPI:1598188666
Name:BURLESON, MONICA (OTR/ L)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BURLESON
Suffix:
Gender:F
Credentials:OTR/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHARTER BLVD
Mailing Address - Street 2:APT 301
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4889
Mailing Address - Country:US
Mailing Address - Phone:404-270-9635
Mailing Address - Fax:
Practice Address - Street 1:1835 SAVOY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1072
Practice Address - Country:US
Practice Address - Phone:678-298-9484
Practice Address - Fax:678-826-4033
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT0003886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist