Individual
KATHLEEN MCSHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
291 BENTLEY AVE, POULTNEY, VT 05764-1177
(802) 342-8065
Mailing address
291 BENTLEY AVE, POULTNEY, VT 05764-1177
(802) 342-8065
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
073.0087973
VT
302R00000X
Health Maintenance Organization
073.0087973
VT
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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