Provider Demographics
NPI:1326062993
Name:HARTENSTEIN, DEBORAH GADDES (OTR CHT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GADDES
Last Name:HARTENSTEIN
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ALBERT CREE DR
Mailing Address - Street 2:VERMONT SPORTS MEDICINE CENTER
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-775-1300
Mailing Address - Fax:802-773-9300
Practice Address - Street 1:5 ALBERT CREE DR
Practice Address - Street 2:VERMONT SPORTS MEDICINE CENTER
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-1300
Practice Address - Fax:802-773-9300
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL91050004792251H1200X
VT0720000005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2136Medicaid
7534587OtherAETNA
VT00018798OtherBCBS
43426OtherMVP
VT00018798OtherBCBS