Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0720000174 | VT |
NPI | 1013275064 |
---|---|
Provider Name | Ms. Rebecca Elisabeth Kodis |
First Address | Bristol, VT 05443-1030 |
Second Address | Bristol, VT 05443-1030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 27/04/2012 |