1851583025 NPI number — DR. KELLY RAYE GAIOTTI PT, DPT, OCS

Table of content: DR. KELLY RAYE GAIOTTI PT, DPT, OCS (NPI 1851583025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851583025 NPI number — DR. KELLY RAYE GAIOTTI PT, DPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAIOTTI
Provider First Name:
KELLY
Provider Middle Name:
RAYE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONG
Provider Other First Name:
KELLY
Provider Other Middle Name:
RAYE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, OCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851583025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 524
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORSET
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-417-7816
Provider Business Mailing Address Fax Number:
802-440-0280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 ROUTE 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORSET
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05251-9661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-867-7056
Provider Business Practice Location Address Fax Number:
802-440-0280
Provider Enumeration Date:
08/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  040.0003797 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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