Healthcare Provider Details

I. General information

NPI: 1902097801
Provider Name (Legal Business Name): MARY C. HEALY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 US RT 4
HARTLAND VT
05048
US

IV. Provider business mailing address

PO BOX 36
TAFTSVILLE VT
05073-0036
US

V. Phone/Fax

Practice location:
  • Phone: 802-457-4487
  • Fax: 802-457-9428
Mailing address:
  • Phone: 802-457-4487
  • Fax: 802-457-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0720000071
License Number StateVT

VIII. Authorized Official

Name: MS. MARY CATHLEEN HEALY
Title or Position: OWNER
Credential: OTR/L, BCP
Phone: 802-457-4487