Provider Demographics
NPI:1609128164
Name:VERMONT CENTER FOR OCCUPATIONAL REHABILIATION
Entity Type:Organization
Organization Name:VERMONT CENTER FOR OCCUPATIONAL REHABILIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OSTEOPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:JOHANSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:802-878-9700
Mailing Address - Street 1:67 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3235
Mailing Address - Country:US
Mailing Address - Phone:802-878-9700
Mailing Address - Fax:802-878-9966
Practice Address - Street 1:67 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3235
Practice Address - Country:US
Practice Address - Phone:802-878-9700
Practice Address - Fax:802-878-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0000304261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine