Provider Demographics
NPI:1386991990
Name:BURGESS, SUSAN LYNETTE (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNETTE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LYNETTE
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:410 PROVIDENCE LANE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-493-4995
Mailing Address - Fax:360-493-4470
Practice Address - Street 1:410 PROVIDENCE LANE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-493-4995
Practice Address - Fax:360-493-4470
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001922225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist