Provider Demographics
NPI:1700843745
Name:BURNISTON, MARJORIE ARLENE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ARLENE
Last Name:BURNISTON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SPARKLEBERRY LN
Mailing Address - Street 2:APARTMENT 902
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6562
Mailing Address - Country:US
Mailing Address - Phone:503-701-8611
Mailing Address - Fax:
Practice Address - Street 1:4500 STUART AVE
Practice Address - Street 2:MACH-OCCUPATIONAL THERAPY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-2377
Practice Address - Fax:803-751-2281
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR1052718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist