Provider Demographics
NPI:1902232499
Name:POMPILIO-FRY, MICHELE (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:POMPILIO-FRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:POMPILIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1111A ETHAN ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:596 SHELDON RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-8011
Practice Address - Country:US
Practice Address - Phone:802-524-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0096464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist