Healthcare Provider Details

I. General information

NPI: 1841871670
Provider Name (Legal Business Name): TAMASIN B. KEKIC OTR/L, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 GOLDTHWAITE RD
CHESTER VT
05143
US

IV. Provider business mailing address

294 GOLDTHWAITE RD
CHESTER VT
05143
US

V. Phone/Fax

Practice location:
  • Phone: 802-779-1741
  • Fax:
Mailing address:
  • Phone: 802-779-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number2648
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number072.0107297
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: