Healthcare Provider Details

I. General information

NPI: 1053779983
Provider Name (Legal Business Name): BARBARA EBENSTEIN MSOT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 DEER CREEK LN
RICHMOND VT
05477-9423
US

IV. Provider business mailing address

51 DEER CREEK LN
RICHMOND VT
05477-9423
US

V. Phone/Fax

Practice location:
  • Phone: 802-434-2652
  • Fax:
Mailing address:
  • Phone: 802-434-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number072.0000010
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: