Healthcare Provider Details

I. General information

NPI: 1730387671
Provider Name (Legal Business Name): HESTER CHARLOTTE BURTON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: H CHARLOTTE BURTON OT

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96555 ALDER RIDGE RD
BROOKINGS OR
97415-8190
US

IV. Provider business mailing address

96555 ALDER RIDGE RD
BROOKINGS OR
97415-8190
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-0540
  • Fax:
Mailing address:
  • Phone: 541-469-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number986365
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: