Healthcare Provider Details

I. General information

NPI: 1619397817
Provider Name (Legal Business Name): CATHY GIFFORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 04/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 PUMPKIN HILL RD
DANVILLE VT
05828-9864
US

IV. Provider business mailing address

327 PUMPKIN HILL RD
DANVILLE VT
05828-9864
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-7292
  • Fax:
Mailing address:
  • Phone: 802-748-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072.0000233
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: