Individual
KEITH ELLOTTE BURROUGH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
300 LABORATORY RD, OAK RIDGE, TN 37830-6911
(865) 482-7698
Mailing address
300 LABORATORY RD, OAK RIDGE, TN 37830-6911
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
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