Provider Demographics
NPI:1437275575
Name:BURTON, JANNEL (OT)
Entity type:Individual
Prefix:
First Name:JANNEL
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 S LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-9335
Mailing Address - Country:US
Mailing Address - Phone:509-888-7048
Mailing Address - Fax:509-888-1968
Practice Address - Street 1:1959 S LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9335
Practice Address - Country:US
Practice Address - Phone:425-653-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020730Medicaid