Healthcare Provider Details

I. General information

NPI: 1801974043
Provider Name (Legal Business Name): DONNA BETH VACHON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 ROUTE 28
WEST YARMOUTH MA
02673-4619
US

IV. Provider business mailing address

19 NOTTINGHAM DR
EAST SANDWICH MA
02537-1315
US

V. Phone/Fax

Practice location:
  • Phone: 508-771-2034
  • Fax: 508-771-5973
Mailing address:
  • Phone: 508-833-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1200
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: