Individual
JACOB MATTHEW BURROUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
2850 JOHNSON FERRY RD STE 100, MARIETTA, GA 30062-5684
(770) 643-0868
(770) 643-0869
Mailing address
2850 JOHNSON FERRY RD STE 100, MARIETTA, GA 30062-5684
(770) 643-0868
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
007999
GA
Other
Enumeration date
02/24/2021
Last updated
02/24/2021
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