Healthcare Provider Details

I. General information

NPI: 1902232499
Provider Name (Legal Business Name): MICHELE POMPILIO-FRY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE POMPILIO OTR

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
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

1111A ETHAN ALLEN AVE
ESSEX JUNCTION VT
05452-4024
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072.0096464
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: