Provider Demographics
NPI:1124470539
Name:BURNETT, MORGAN LINDSEY (OT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LINDSEY
Last Name:BURNETT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HOLLY BUSH RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8598
Mailing Address - Country:US
Mailing Address - Phone:601-260-2854
Mailing Address - Fax:
Practice Address - Street 1:7712 OLD CANTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9299
Practice Address - Country:US
Practice Address - Phone:601-427-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist