Individual
TINA LISSET BURGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2720 S VEITCH ST APT 209, ARLINGTON, VA 22206-3072
(646) 305-4195
Mailing address
2720 S VEITCH STREET APT. 209, ARLINGTON, VA 22206
(646) 305-4195
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006127
NY
Other
Enumeration date
03/06/2012
Last updated
03/06/2012
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