Provider Demographics
NPI:1902097801
Name:MARY C. HEALY
Entity Type:Organization
Organization Name:MARY C. HEALY
Other - Org Name:THERAPEUTIC DIMENSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, BCP
Authorized Official - Phone:802-457-4487
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:TAFTSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05073-0036
Mailing Address - Country:US
Mailing Address - Phone:802-457-4487
Mailing Address - Fax:802-457-9428
Practice Address - Street 1:57 US RT 4
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:VT
Practice Address - Zip Code:05048
Practice Address - Country:US
Practice Address - Phone:802-457-4487
Practice Address - Fax:802-457-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000071225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOTSE00019121OtherVT BLUECROSSBLUESHIELD