Provider Demographics
NPI:1851645444
Name:ROBERTS, BRENDA LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:COTA/L
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 92
Mailing Address - Street 2:
Mailing Address - City:WEST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05871-0092
Mailing Address - Country:US
Mailing Address - Phone:802-467-8748
Mailing Address - Fax:
Practice Address - Street 1:47 MAGGIES POND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:VT
Practice Address - Zip Code:05841-8800
Practice Address - Country:US
Practice Address - Phone:802-533-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.0090632224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant