Individual
MS. DAISY NICHOLSON BURGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6700 ANTIOCH RD, SUITE 430, MERRIAM, KS 66204
(828) 817-3931
Mailing address
PO BOX 9934, KANSAS CITY, MO 64134-0934
(828) 817-3931
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2010041102
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010041102
STATE OF MISSOUR BOARD OF OCCUPATIONAL THERAPY
MO
Enumeration date
12/17/2010
Last updated
12/17/2010
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