Individual
HALEY BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
920 E AVENUE L, SILSBEE, TX 77656-5014
(409) 385-5571
Mailing address
7930 BLUE BONNET LN, BEAUMONT, TX 77713-9205
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
213547
TX
224Z00000X
Occupational Therapy Assistant
Primary
9805
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A63821026
IMA
TX
Enumeration date
01/25/2019
Last updated
01/25/2019
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