Individual
JENNA REBECCA BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1201 BROAD ROCK BLVD, RICHMOND, VA 23249-0001
(804) 675-5000
Mailing address
2802 PIN OAK LN, SANDSTON, VA 23150-2714
(804) 737-4529
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004261
VA
Other
Enumeration date
02/02/2007
Last updated
07/08/2007
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