Healthcare Provider Details

I. General information

NPI: 1063471100
Provider Name (Legal Business Name): KIMBERLY A ALERCIO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PERKINS ST
ST JOHNSBURY VT
05819-1934
US

IV. Provider business mailing address

268 BAKER LN
CONCORD VT
05824-9418
US

V. Phone/Fax

Practice location:
  • Phone: 609-433-3438
  • Fax:
Mailing address:
  • Phone: 609-433-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberTR01031
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072-0000588
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: