Healthcare Provider Details

I. General information

NPI: 1497014591
Provider Name (Legal Business Name): LINDA BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 POR LA MAR CIR
SANTA BARBARA CA
93103-3775
US

IV. Provider business mailing address

135 POR LA MAR CIR
SANTA BARBARA CA
93103-3775
US

V. Phone/Fax

Practice location:
  • Phone: 202-679-2209
  • Fax:
Mailing address:
  • Phone: 202-679-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: