Provider Demographics
NPI:1104003821
Name:MID VERMONT HAND THERAPY AND ERGONOMICS
Entity Type:Organization
Organization Name:MID VERMONT HAND THERAPY AND ERGONOMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:802-747-0540
Mailing Address - Street 1:135 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3238
Mailing Address - Country:US
Mailing Address - Phone:802-747-0540
Mailing Address - Fax:
Practice Address - Street 1:135 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3238
Practice Address - Country:US
Practice Address - Phone:802-747-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT4608590001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN2947OtherMEDICARE
VT1008974Medicaid
VT1008974Medicaid