Provider Demographics
NPI:1871895235
Name:BURNELL, LAURIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:BURNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 CHRISTOPHER CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8765
Mailing Address - Country:US
Mailing Address - Phone:317-839-0555
Mailing Address - Fax:
Practice Address - Street 1:8116 CHRISTOPHER CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8765
Practice Address - Country:US
Practice Address - Phone:317-839-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001107A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200175630AMedicaid