Provider Demographics
NPI:1922218494
Name:BURG, FRANCINE E (OTR L, LMP)
Entity type:Individual
Prefix:MS
First Name:FRANCINE
Middle Name:E
Last Name:BURG
Suffix:
Gender:F
Credentials:OTR L, LMP
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 236
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-0236
Mailing Address - Country:US
Mailing Address - Phone:360-446-5755
Mailing Address - Fax:
Practice Address - Street 1:1015 4TH AVE W
Practice Address - Street 2:SUITE G
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5467
Practice Address - Country:US
Practice Address - Phone:360-339-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021442225700000X
WAOT00003813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist