Healthcare Provider Details

I. General information

NPI: 1093627531
Provider Name (Legal Business Name): ELLERY BURTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 CASTIGLIONE ST
NEW ORLEANS LA
70119-2236
US

IV. Provider business mailing address

2706 CASTIGLIONE ST
NEW ORLEANS LA
70119-2236
US

V. Phone/Fax

Practice location:
  • Phone: 818-635-0435
  • Fax:
Mailing address:
  • Phone: 818-635-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number352352
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: