Individual
TRAVIS BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3800 INDEPENDENCE BLVD, WILMINGTON, NC 28412-2599
(910) 392-3110
Mailing address
518 MORNINGSIDE DR, WILMINGTON, NC 28401-7241
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
2856224
MI
224Z00000X
Occupational Therapy Assistant
Primary
7802
NC
Other
Enumeration date
01/26/2013
Last updated
01/26/2013
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