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

Table of content: TINA MARIE MCCARTHY LCSW-C (NPI 1932270212)

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)





Copyright © 2007-2025 www.npivalidator.com