Provider Demographics
NPI:1265520639
Name:BURROWS, THERESA DIANE (OTR L)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:DIANE
Last Name:BURROWS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:DIANE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:111 S. RAILROAD AVE.
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4853
Mailing Address - Country:US
Mailing Address - Phone:910-892-0027
Mailing Address - Fax:910-892-0029
Practice Address - Street 1:1100 S CLINTON AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-0027
Practice Address - Fax:910-892-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211634Medicaid
346639Medicare ID - Type Unspecified