Healthcare Provider Details

I. General information

NPI: 1760694244
Provider Name (Legal Business Name): LAURIE BURTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PILLSBURY ST SUITE 404
CONCORD NH
03301-3523
US

IV. Provider business mailing address

162 SAWTOOTH RD
GILMANTON NH
03237-4511
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1029
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: