Provider Demographics
NPI:1932772571
Name:EQUIPOISE OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:EQUIPOISE OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMASIN
Authorized Official - Middle Name:BALLOU
Authorized Official - Last Name:KEKIC
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:802-779-1741
Mailing Address - Street 1:294 GOLDTHWAITE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-9131
Mailing Address - Country:US
Mailing Address - Phone:802-779-1741
Mailing Address - Fax:
Practice Address - Street 1:294 GOLDTHWAITE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143-9131
Practice Address - Country:US
Practice Address - Phone:802-779-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty