Healthcare Provider Details

I. General information

NPI: 1356476550
Provider Name (Legal Business Name): REBECCA HELEN CHOQUETTE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PATRICK GYMNASIUM UNIVERSITY OF VERMONT
BURLINGTON VT
05468
US

IV. Provider business mailing address

27 KENDRA DR.
MILTON VT
05468
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-9575
  • Fax: 802-656-9578
Mailing address:
  • Phone: 802-656-9575
  • Fax: 802-656-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number104-0000038
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: