Provider Demographics
NPI:1013143270
Name:BURGESS, JEANNIE MARIE (OT/R)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:OT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10685 FINK RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-7610
Mailing Address - Country:US
Mailing Address - Phone:704-492-9631
Mailing Address - Fax:
Practice Address - Street 1:8594 PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-7610
Practice Address - Country:US
Practice Address - Phone:704-492-9631
Practice Address - Fax:704-665-5691
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9952225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist