Healthcare Provider Details

I. General information

NPI: 1518478791
Provider Name (Legal Business Name): BLACK TURTLE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 MAIN STREET
PLAINFIELD VT
05667
US

IV. Provider business mailing address

P.O. BOX 205
PLAINFIELD VT
05667
US

V. Phone/Fax

Practice location:
  • Phone: 802-322-5005
  • Fax: 802-322-5005
Mailing address:
  • Phone: 802-322-5005
  • Fax: 802-322-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: BAYLEN SLOTE
Title or Position: OWNER OPERATOR
Credential: L.AC.
Phone: 802-322-5005