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General NPI Number Information
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NPI Number | 1629920384
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Entity Type | Individual
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Provider Name | EVAN LAMOTHE
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Gender | Male
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 4 GAUTHIER DR STE A
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-2825
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Country | US
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Telephone | 802-879-7734
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Fax |
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Provider Business Mailing Address
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Address Line | 160 HAWKES WAY
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City | COLCHESTER
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State | VT
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Zip | 05446-5992
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Country | US
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Telephone | 802-923-6243
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 040.0135013
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License Number State | VT
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