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NPI Code Detail

MEDICARE: JESSAMY KAYE BURCH MOTR/L

MEDICARE: JESSAMY KAYE BURCH MOTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist002060IA

General Provider Information

NPI Number : 1811244775
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSAMY KAYE BURCH MOTR/L
Provider Business Mailing Address
First Line : 3801 OLD BRUCEVILLE RD
Second Line :
City : VINCENNES
State : IN
Zip : 47591-3889
Country : US
Telephone Number : 812-886-4677
Fax Number : 812-886-4678
Provider Business Practice Location Address
First Line : 4614 84TH ST
Second Line :
City : URBANDALE
State : IA
Zip : 50322-1089
Country : US
Telephone Number : 515-270-6838
Fax Number : 515-270-8051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2012
Last Update Date : 08/10/2012

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