Provider Demographics
NPI:1134325483
Name:YANCEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:YANCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HERRINGTON
Other - Last Name:YANCEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED OTRL
Mailing Address - Street 1:22 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353-9752
Mailing Address - Country:US
Mailing Address - Phone:802-365-4141
Mailing Address - Fax:
Practice Address - Street 1:88 PARK ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4710
Practice Address - Country:US
Practice Address - Phone:802-775-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000388225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics