Healthcare Provider Details

I. General information

NPI: 1275648883
Provider Name (Legal Business Name): ELIZABETH BLUM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 US ROUTE 5 SOJOURNS COMMUNITY HEALTH CLINIC
WESTMINSTER VT
05158-9651
US

IV. Provider business mailing address

4923 US ROUTE 5 SOJOURNS COMMUNITY HEALTH CLINIC
WESTMINSTER VT
05158-9651
US

V. Phone/Fax

Practice location:
  • Phone: 802-722-4023
  • Fax: 802-722-4137
Mailing address:
  • Phone: 802-722-4023
  • Fax: 802-722-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072-0000004
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: