Provider Demographics
NPI:1477712289
Name:PATRICK, UTE S (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:UTE
Middle Name:S
Last Name:PATRICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ELM ST
Mailing Address - Street 2:UNIT #8
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-8408
Mailing Address - Country:US
Mailing Address - Phone:973-405-4411
Mailing Address - Fax:
Practice Address - Street 1:56 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-8408
Practice Address - Country:US
Practice Address - Phone:973-405-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0102450225XP0200X
NJ46TR00417400225X00000X
NY014649-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist