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General NPI Number Information
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NPI Number | 1518494426
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Entity Type | Individual
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Provider Name | TODD RUSSELL REXFORD COTA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 05/23/2017
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Provider Practice Location Address
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Address Line | 1248 HOSPITAL DR
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-9239
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Country | US
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Telephone | 802-424-4903
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Fax |
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Provider Business Mailing Address
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Address Line | 432 JILLS HILL RD
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City | LYNDONVILLE
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State | VT
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Zip | 05851-9406
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Country | US
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Telephone | 802-626-8214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0730000112
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License Number State | VT
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