Provider Demographics
NPI:1801567243
Name:THE VAULT: HAND CRAFTED WELLNESS, LLC
Entity type:Organization
Organization Name:THE VAULT: HAND CRAFTED WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARTISS-EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OT/L, CHT
Authorized Official - Phone:203-376-5646
Mailing Address - Street 1:12 BRICK WALK LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2368
Mailing Address - Country:US
Mailing Address - Phone:203-376-5646
Mailing Address - Fax:
Practice Address - Street 1:12 BRICK WALK LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2368
Practice Address - Country:US
Practice Address - Phone:203-376-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty