Healthcare Provider Details

I. General information

NPI: 1215386321
Provider Name (Legal Business Name): HEATHER CHADWICK B.S.,C.M.T.,M.M.P.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HUNTINGTON RD
RICHMOND VT
05477-9708
US

IV. Provider business mailing address

1147 E MAIN ST
RICHMOND VT
05477-9661
US

V. Phone/Fax

Practice location:
  • Phone: 802-318-1423
  • Fax:
Mailing address:
  • Phone: 802-318-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: