Provider Demographics
NPI:1700549607
Name:BURGO, HEIDI MARIE (THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARIE
Last Name:BURGO
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:BURGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COT/L
Mailing Address - Street 1:198 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4138
Mailing Address - Country:US
Mailing Address - Phone:508-558-1987
Mailing Address - Fax:
Practice Address - Street 1:68 DEAN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2713
Practice Address - Country:US
Practice Address - Phone:800-385-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant