Active NPI
Kimberly Marie Burgess, DT/H
- Developmental Therapist
- Peoria, IL
National Provider Identifier
1013103506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- B622-5138-3710
- Practice address
- 6440 N Allen Rd
Unit 55
Peoria, IL 61614-3281 - Phone
- (309) 838-5440
- NPI assigned
- Sep 19, 2007
- Last updated
- Sep 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | B622-5138-3710 | IL | Primary |
Addresses
Primary practice location
6440 N Allen Rd
Unit 55
Peoria, IL 61614-3281
Mailing address
6440 N Allen Rd
Unit 55
Peoria, IL 61614-3281
Phone (309) 838-5440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B622-5138-3710 | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1013103506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6440 N ALLEN RD",
"address_2": "UNIT 55",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143281",
"telephone_number": "309-838-5440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6440 N ALLEN RD",
"address_2": "UNIT 55",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143281",
"telephone_number": "309-838-5440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "KIMBERLY",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "DT/H",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "B622-5138-3710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.