Healthcare Provider Details

I. General information

NPI: 1609936335
Provider Name (Legal Business Name): MARIE-CHRISTINE POTVIN O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PRIM RD
COLCHESTER VT
05446-6403
US

IV. Provider business mailing address

24 ELM ST
WINOOSKI VT
05404-1751
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-1900
  • Fax:
Mailing address:
  • Phone: 802-655-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number072-0000347
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: