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NPI Code Detail

MEDICARE: MRS. CHRISTINE DENISE PETTERSON OTR

MEDICARE:  MRS. CHRISTINE DENISE PETTERSON  OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist072-0000464VT

General Provider Information

NPI Number : 1174691000
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINE DENISE PETTERSON OTR
Provider Business Mailing Address
First Line : 60 ABIGAIL DR
Second Line :
City : COLCHESTER
State : VT
Zip : 05446-3875
Country : US
Telephone Number : 802-655-4240
Fax Number :
Provider Business Practice Location Address
First Line : 4066 SHELBURNE RD
Second Line : SUITE 8
City : SHELBURNE
State : VT
Zip : 05482-6905
Country : US
Telephone Number : 802-985-8211
Fax Number : 802-985-8733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. CHRISTINE DENISE PETTERSON OTR” Practice Location

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