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NPI Code Detail

MEDICARE: MS. MARILYN BURGESS COTA/L

MEDICARE: MS. MARILYN BURGESS COTA/L
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
1225X00000XOccupational TherapistOTA0000001179TN

General Provider Information

NPI Number : 1508201716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARILYN BURGESS COTA/L
Provider Business Mailing Address
First Line : 111 ROBERT PORTER RD
Second Line :
City : DICKSON
State : TN
Zip : 37055-3318
Country : US
Telephone Number : 615-740-1080
Fax Number :
Provider Business Practice Location Address
First Line : 115 ACADEMY ST
Second Line :
City : DICKSON
State : TN
Zip : 37055-2013
Country : US
Telephone Number : 615-446-2085
Fax Number : 615-441-4132
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2013
Last Update Date : 05/01/2013

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