Provider Demographics
NPI:1639566268
Name:HULTGREN, MARY LAURA NAYLOR (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LAURA NAYLOR
Last Name:HULTGREN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LAURA
Other - Last Name:NAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:314 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-9167
Mailing Address - Country:US
Mailing Address - Phone:540-222-7292
Mailing Address - Fax:
Practice Address - Street 1:7254 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9531
Practice Address - Country:US
Practice Address - Phone:802-362-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist