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NPI Code Detail

MEDICARE: VERMONT CENTER FOR OCCUPATIONAL REHABILIATION

MEDICARE: VERMONT CENTER FOR OCCUPATIONAL REHABILIATION
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
1261QX0100XOccupational Medicine Clinic/Center032.0000304VT

General Provider Information

NPI Number : 1609128164
Entity Type Code : Organization
Provider Name (Legal Business Name) : VERMONT CENTER FOR OCCUPATIONAL REHABILIATION
Provider Business Mailing Address
First Line : 67 LINCOLN ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3235
Country : US
Telephone Number : 802-878-9700
Fax Number : 802-878-9966
Provider Business Practice Location Address
First Line : 67 LINCOLN ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3235
Country : US
Telephone Number : 802-878-9700
Fax Number : 802-878-9966
Authorized Official
Title or Position : OSTEOPATHIC PHYSICIAN
Name : DR. JOHN RUSSELL JOHANSSON
Credential : D.O.
Telephone Number : 802-878-9700
Provider Enumeration Date : 10/09/2012
Last Update Date : 10/09/2012

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Directions to “VERMONT CENTER FOR OCCUPATIONAL REHABILIATION ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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