Individual
AUDREY BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
52654 IRONWOOD RD, SOUTH BEND, IN 46635-1123
(574) 277-8710
Mailing address
52654 IRONWOOD RD, SOUTH BEND, IN 46635-1123
(574) 277-8710
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001574A
IN
Other
Enumeration date
08/22/2008
Last updated
08/22/2008
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