Healthcare Provider Details

I. General information

NPI: 1538082284
Provider Name (Legal Business Name): GREEN MOUNTAIN PELVIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MAIN ST
BENNINGTON VT
05201-3049
US

IV. Provider business mailing address

314 LAKE DR
NORTH BENNINGTON VT
05257-9167
US

V. Phone/Fax

Practice location:
  • Phone: 802-736-6218
  • Fax: 802-277-7309
Mailing address:
  • Phone: 802-736-6218
  • Fax: 802-277-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARY LAURA NAYLOR HULTGREN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOTR/L
Phone: 802-736-6218