Healthcare Provider Details

I. General information

NPI: 1922836436
Provider Name (Legal Business Name): NORTHEAST KINGDOM OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
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 TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ALERCIO
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 609-433-3438