Individual
KEITH ELLOTTE BURROUGH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2951
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2951
—
TN
Enumeration date
02/24/2018
Last updated
02/24/2018
Update your record
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