Provider Demographics
NPI:1831489285
Name:HENRIKSSON, BEATRICE L (COTA)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:L
Last Name:HENRIKSSON
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 445
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-0445
Mailing Address - Country:US
Mailing Address - Phone:518-396-9083
Mailing Address - Fax:
Practice Address - Street 1:61 GREENWAY DR.
Practice Address - Street 2:VERNON HOUSE
Practice Address - City:VERNON
Practice Address - State:VT
Practice Address - Zip Code:05354-9474
Practice Address - Country:US
Practice Address - Phone:802-254-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.0075595224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant