Provider Demographics
NPI:1619077104
Name:BURD, GAIL L (OTR)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:BURD
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 1:121 EZEE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3848
Mailing Address - Country:US
Mailing Address - Phone:423-543-8703
Mailing Address - Fax:
Practice Address - Street 1:245 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3274
Practice Address - Country:US
Practice Address - Phone:276-669-4711
Practice Address - Fax:276-669-0834
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000188OtherTN LICENSE NUMBER
VA2191OtherVA LICENSE NUMBER