Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 072-0000071 | VT |
NPI | 1053486951 |
---|---|
Provider Name | Ms. Mary Cathleen Healy |
First Address | Norwich, VT 05055-0349 |
Second Address | Taftsville, VT 05073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1308739Y0VT01 | ANTHEM (01) | NH |
19119 | BLUE CROSS BLUE SHIELD (01) | VT |