Provider Demographics
NPI:1477788156
Name:CHESTNA, PHOEBE J (OTR/L)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:J
Last Name:CHESTNA
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 1:4694 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05733-9689
Mailing Address - Country:US
Mailing Address - Phone:802-345-6450
Mailing Address - Fax:
Practice Address - Street 1:4694 ROUTE 30
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:VT
Practice Address - Zip Code:05733-9689
Practice Address - Country:US
Practice Address - Phone:802-345-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-24
Last Update Date:2009-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000019225X00000X, 225XP0200X
MA9642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist