Individual
MR. STEPHEN JOHN BLACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
46 NICHOLS ST, RUTLAND, VT 05701-3275
(802) 775-2941
Mailing address
486 TOWN FARM RD, BRANDON, VT 05733-9098
(802) 247-6340
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
041-0000401
VT
Other
Enumeration date
06/15/2007
Last updated
07/08/2007
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