Healthcare Provider Details

I. General information

NPI: 1306955273
Provider Name (Legal Business Name): KRISTIN S BREWSTER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN S BOUCHER OTR

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 COLLEGE PKWY
COLCHESTER VT
05446-3052
US

IV. Provider business mailing address

75 LAWNWOOD DR
WILLISTON VT
05495-9599
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0105
  • Fax:
Mailing address:
  • Phone: 802-879-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072-0000098
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: