Individual
MRS. ANDREA LEA BURLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Mailing address
17 CHAPEL CREEK LN, SHREVEPORT, LA 71106-8553
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
Z11235
LA
Other
Enumeration date
07/12/2017
Last updated
07/12/2017
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