Provider Demographics
NPI:1447596820
Name:OTTER CREEK THERAPIES
Entity Type:Organization
Organization Name:OTTER CREEK THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOVE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:802-247-5998
Mailing Address - Street 1:13 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-8408
Mailing Address - Country:US
Mailing Address - Phone:802-247-5998
Mailing Address - Fax:
Practice Address - Street 1:13 ADAMS RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-8408
Practice Address - Country:US
Practice Address - Phone:802-247-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty