Healthcare Provider Details

I. General information

NPI: 1770414658
Provider Name (Legal Business Name): KENNEDY MARISA BAGGOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 BLAIR PARK RD UNIT 201
WILLISTON VT
05495-8056
US

IV. Provider business mailing address

88 MORSE DR
SHELBURNE VT
05482-6425
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-6988
  • Fax:
Mailing address:
  • Phone: 860-798-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0002127
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: