Provider Demographics
NPI:1447687868
Name:BURGESS, JACQUELINE L (OTR/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:BURGESS
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 JIM FORSYTHE LN
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-8964
Mailing Address - Country:US
Mailing Address - Phone:859-612-1311
Mailing Address - Fax:
Practice Address - Street 1:642 N 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1125
Practice Address - Country:US
Practice Address - Phone:859-612-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
IN31005490A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist