Provider Demographics
NPI:1679191134
Name:FRESH, ANEMONE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:ANEMONE
Middle Name:
Last Name:FRESH
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1606
Mailing Address - Country:US
Mailing Address - Phone:802-989-7882
Mailing Address - Fax:802-989-7881
Practice Address - Street 1:228 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1606
Practice Address - Country:US
Practice Address - Phone:802-989-7882
Practice Address - Fax:802-989-7881
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0134056171100000X
OR194825171100000X
OR4288175F00000X
OR22274225700000X
VT099.0134151175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist