MEDICARE: AVERY LEMNAH

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
1	2255A2300X	Athletic Trainer	104.0112336	VT

General Provider Information

NPI Number	:	1790178234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY LEMNAH

Provider Business Mailing Address
First Line	:	PO BOX 268
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-0268
Country	:	US
Telephone Number	:	802-681-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-0354
Fax Number	:	802-489-5182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	06/09/2015

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Directions to “ AVERY LEMNAH ” Practice Location

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