Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 072.0075464 | VT |
NPI | 1063701563 |
---|---|
Provider Name | Tasia Carlyle |
First Address | Barre, VT 05641-5219 |
Second Address | Saint Albans, VT 05478-8011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 05/04/2011 |