Provider Demographics
NPI:1922836436
Name:NORTHEAST KINGDOM OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:NORTHEAST KINGDOM OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALERCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:609-433-3438
Mailing Address - Street 1:268 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:VT
Mailing Address - Zip Code:05824-9418
Mailing Address - Country:US
Mailing Address - Phone:609-433-3438
Mailing Address - Fax:
Practice Address - Street 1:49 PERKINS ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1934
Practice Address - Country:US
Practice Address - Phone:609-433-3438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty