Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 073-0000049 | VT |
NPI | 1003092768 |
---|---|
Provider Name | Mrs. Diane E Bousquet |
First Address | Andover, MA 01810-1437 |
Second Address | Vernon, VT 05354-9474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2008 |
Last Update Date | 12/01/2008 |