Healthcare Provider Details

I. General information

NPI: 1497603864
Provider Name (Legal Business Name): AVERY HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 BLAIR PARK RD
WILLISTON VT
05495-8037
US

IV. Provider business mailing address

200 ELM ST
MONTPELIER VT
05602-2205
US

V. Phone/Fax

Practice location:
  • Phone: 802-876-7187
  • Fax:
Mailing address:
  • Phone: 802-223-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0001833
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: