Basic Information
| Provider Information | |||||||||
| NPI: | 1235431834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIESTERER | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 679 CAMPBROOK RD | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050329069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022345274 | ||||||||
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| Practice Location | |||||||||
| Address1: | 46 NICHOLS ST. | ||||||||
| Address2: | RUTLAND HEALTHCARE AND REHABILITATION CENTER | ||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027752941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0730000138 | VT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.