Healthcare Provider Details

I. General information

NPI: 1760142632
Provider Name (Legal Business Name): ROCK RIVER THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 GOOSE CITY RD
EAST DOVER VT
05341
US

IV. Provider business mailing address

PO BOX 162
EAST DOVER VT
05341-0162
US

V. Phone/Fax

Practice location:
  • Phone: 802-319-9319
  • Fax:
Mailing address:
  • Phone: 802-319-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGAN WOODBERRY
Title or Position: OCCUPATIONAL THERAPIST, OWNER
Credential:
Phone: 802-319-9319