MEDICARE: MRS. JEANNIE MARIE BURGESS OT/R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	9952	NC

General Provider Information

NPI Number	:	1013143270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNIE MARIE BURGESS OT/R

Provider Business Mailing Address
First Line	:	10685 FINK RD
Second Line	:
City	:	MT PLEASANT
State	:	NC
Zip	:	28124-7610
Country	:	US
Telephone Number	:	980-290-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	8594 PARK DR
Second Line	:
City	:	MT PLEASANT
State	:	NC
Zip	:	28124-8402
Country	:	US
Telephone Number	:	980-290-7311
Fax Number	:	704-665-5691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	01/29/2026

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