Provider Demographics
NPI:1184147597
Name:LAMOTHE, OLIVIA (LPN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 OLD SILO RD
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8979
Mailing Address - Country:US
Mailing Address - Phone:802-274-7604
Mailing Address - Fax:
Practice Address - Street 1:2895 OLD SILO RD
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8979
Practice Address - Country:US
Practice Address - Phone:802-274-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0131790164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse