Healthcare Provider Details

I. General information

NPI: 1790236156
Provider Name (Legal Business Name): BARBARA ANN MIZRAHI OT/RL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. BARBARA ANN HIEDEMANN

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 GUILFORD CENTER RD
GUILFORD VT
05301-8711
US

IV. Provider business mailing address

3531 GUILFORD CENTER RD
GUILFORD VT
05301-8711
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-9259
  • Fax:
Mailing address:
  • Phone: 802-254-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number12094
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number072.0103363
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: