Provider Demographics
NPI:1053486951
Name:HEALY, MARY CATHLEEN
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHLEEN
Last Name:HEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RTS 4 & 12
Practice Address - Street 2:
Practice Address - City:TAFTSVILLE
Practice Address - State:VT
Practice Address - Zip Code:05073
Practice Address - Country:US
Practice Address - Phone:802-457-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000071225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1308739Y0VT01OtherANTHEM
VT19119OtherBLUE CROSS BLUE SHIELD