Provider Demographics
NPI:1215051941
Name:BURTON, KELLY (OT)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:
Last Name:BURTON
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 1:1897 BURTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BARNEY
Mailing Address - State:GA
Mailing Address - Zip Code:31625-1901
Mailing Address - Country:US
Mailing Address - Phone:229-588-0304
Mailing Address - Fax:
Practice Address - Street 1:777 GLADES ROAD
Practice Address - Street 2:SUITE 215
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-989-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU0T003434225X00000X
SC2979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist