Individual
KEITH DESILETS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
105 CHESTER RD, SPRINGFIELD, VT 05156-2106
(802) 885-5741
Mailing address
12 BLOCK AVE APT 2, CLAREMONT, NH 03743-5150
(413) 519-7061
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
073.0123506
VT
Other
Enumeration date
09/03/2016
Last updated
09/03/2016
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