Provider Demographics
NPI:1891879102
Name:BURRIS, JULIE S (OTR/L,CLT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:S
Last Name:BURRIS
Suffix:
Gender:F
Credentials:OTR/L,CLT
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 4177
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4177
Mailing Address - Country:US
Mailing Address - Phone:910-295-2609
Mailing Address - Fax:910-295-0026
Practice Address - Street 1:5 DOWD CIR
Practice Address - Street 2:SUITE A
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7932
Practice Address - Country:US
Practice Address - Phone:910-295-2609
Practice Address - Fax:910-295-0026
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3804225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143C9OtherBCBS
NC7411996Medicaid