Healthcare Provider Details

I. General information

NPI: 1306436258
Provider Name (Legal Business Name): JOCELYN BURR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 S MILLENIUM WAY STE 120
MERIDIAN ID
83642-1510
US

IV. Provider business mailing address

1857 S MILLENIUM WAY STE 120
MERIDIAN ID
83642-1510
US

V. Phone/Fax

Practice location:
  • Phone: 208-600-0722
  • Fax:
Mailing address:
  • Phone: 208-600-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9681112
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: