Healthcare Provider Details

I. General information

NPI: 1811291677
Provider Name (Legal Business Name): STEFANIE ANN BURTON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GOSSMAN RD
SOUTHERN PINES NC
28387-2225
US

IV. Provider business mailing address

95 PINKERTON COR
FAIRVIEW NC
28730-7737
US

V. Phone/Fax

Practice location:
  • Phone: 910-246-1000
  • Fax:
Mailing address:
  • Phone: 215-480-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: