Provider Demographics
NPI:1316085871
Name:BURTON, HEIDEMARIE (OTR)
Entity type:Individual
Prefix:
First Name:HEIDEMARIE
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MONAGHAN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5962
Mailing Address - Country:US
Mailing Address - Phone:931-472-9569
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DRIVE
Practice Address - Street 2:BLANCHFIEL ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:931-472-9569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist