Provider Demographics
NPI:1184868580
Name:BURDSALL, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:BURDSALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SOPWITH DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9115
Mailing Address - Country:US
Mailing Address - Phone:772-216-4339
Mailing Address - Fax:772-770-1970
Practice Address - Street 1:420 SOPWITH DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-9115
Practice Address - Country:US
Practice Address - Phone:772-216-4339
Practice Address - Fax:772-770-1970
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist