Provider Demographics
NPI:1790371912
Name:BURCH, JANINE EVELYN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:EVELYN
Last Name:BURCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JANINE
Other - Middle Name:EVELYN
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 LONDONDERRY TPKE
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1977
Mailing Address - Country:US
Mailing Address - Phone:603-621-9870
Mailing Address - Fax:603-621-9875
Practice Address - Street 1:171 LONDONDERRY TPKE
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1977
Practice Address - Country:US
Practice Address - Phone:603-621-9870
Practice Address - Fax:603-621-9875
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NH3007225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3132894Medicaid