Provider Demographics
NPI:1891755161
Name:BURNS, EMILY DIANE (BSOT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DIANE
Last Name:BURNS
Suffix:
Gender:F
Credentials:BSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:615-342-6300
Mailing Address - Fax:
Practice Address - Street 1:515 RIVERGATE PKWY
Practice Address - Street 2:201
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-859-7775
Practice Address - Fax:615-859-7772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare ID - Type UnspecifiedGROUP