Provider Demographics
NPI:1790178234
Name:LEMNAH, AVERY
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:LEMNAH
Suffix:
Gender:F
Credentials:
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 268
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-0268
Mailing Address - Country:US
Mailing Address - Phone:802-681-8638
Mailing Address - Fax:
Practice Address - Street 1:440 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1338
Practice Address - Country:US
Practice Address - Phone:802-655-0354
Practice Address - Fax:802-489-5182
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.01123362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer