Provider Demographics
NPI:1750821914
Name:BURNAUGH, ALICEA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ALICEA
Middle Name:
Last Name:BURNAUGH
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:ALICEA
Other - Middle Name:
Other - Last Name:STEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1597 AVENUE D STE 4
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3010
Mailing Address - Country:US
Mailing Address - Phone:406-690-6996
Mailing Address - Fax:406-206-5262
Practice Address - Street 1:1597 AVENUE D
Practice Address - Street 2:SUITE 4
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3010
Practice Address - Country:US
Practice Address - Phone:406-690-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-4638225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics