Provider Demographics
NPI:1336224724
Name:OUELLETTE-MORTON, REBECCA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:OUELLETTE-MORTON
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 1:276 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-3108
Mailing Address - Country:US
Mailing Address - Phone:802-482-3213
Mailing Address - Fax:
Practice Address - Street 1:30 HAWTHORNE ST
Practice Address - Street 2:MAPLE TREE PLACE
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8212
Practice Address - Country:US
Practice Address - Phone:802-876-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00069556OtherBCBS
VT1012971Medicaid