Provider Demographics
NPI:1326758251
Name:FLETCHER, MACIE S (OTD)
Entity Type:Individual
Prefix:
First Name:MACIE
Middle Name:S
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 FULLER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-9415
Mailing Address - Country:US
Mailing Address - Phone:802-393-5822
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0134319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist