Healthcare Provider Details

I. General information

NPI: 1629687116
Provider Name (Legal Business Name): SHERRY JEANNE PIDGEON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 PUMPKIN HL
WILLISTON VT
05495-9008
US

IV. Provider business mailing address

376 PUMPKIN HL
WILLISTON VT
05495-9008
US

V. Phone/Fax

Practice location:
  • Phone: 802-578-3440
  • Fax:
Mailing address:
  • Phone: 802-578-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072.0000248
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number072.0000-248
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: