Provider Demographics
NPI:1780829762
Name:FREDETTE, KERRI N (COTA)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:N
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:EAST BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05649-0495
Mailing Address - Country:US
Mailing Address - Phone:802-476-8731
Mailing Address - Fax:
Practice Address - Street 1:71 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5644
Practice Address - Country:US
Practice Address - Phone:802-485-3161
Practice Address - Fax:802-485-6307
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073-0000149224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant