Healthcare Provider Details

I. General information

NPI: 1316000284
Provider Name (Legal Business Name): CARLOS OTIS STRATTON MT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 FOUNDERS HILL ROAD
STRATTON MT VT
05155
US

IV. Provider business mailing address

PO BOX 617
STRATTON MT VT
05155
US

V. Phone/Fax

Practice location:
  • Phone: 802-297-2300
  • Fax: 802-297-3412
Mailing address:
  • Phone: 802-297-2300
  • Fax: 802-297-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY BETH HAND
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 802-297-2300