Healthcare Provider Details

I. General information

NPI: 1710172671
Provider Name (Legal Business Name): LINDA M KOGUT MA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 STONEFENCE RD
RICHMOND VT
05477-2202
US

IV. Provider business mailing address

29 STONEFENCE RD
RICHMOND VT
05477-2202
US

V. Phone/Fax

Practice location:
  • Phone: 802-434-4036
  • Fax: 802-434-4036
Mailing address:
  • Phone: 802-434-4036
  • Fax: 802-434-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number072.0000063
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: