Healthcare Provider Details

I. General information

NPI: 1790741239
Provider Name (Legal Business Name): PAQUETTE THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARKET PL UNIT 27 & 33
ESSEX JCT VT
05452-2942
US

IV. Provider business mailing address

1 MARKET PL UNIT 27 & 33
ESSEX JCT VT
05452-2942
US

V. Phone/Fax

Practice location:
  • Phone: 802-871-5350
  • Fax: 802-871-5351
Mailing address:
  • Phone: 802-871-5350
  • Fax: 802-871-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0400002526
License Number StateVT

VIII. Authorized Official

Name: MRS. VERONICA LEE PAQUETTE
Title or Position: OWNER
Credential: PT
Phone: 802-871-5350