Healthcare Provider Details

I. General information

NPI: 1720647001
Provider Name (Legal Business Name): AMY RIXON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 SHELDON RD
SAINT ALBANS VT
05478-8011
US

IV. Provider business mailing address

85 BANK ST
SAINT ALBANS VT
05478-1780
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-6534
  • Fax:
Mailing address:
  • Phone: 802-752-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072.0134074
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: