Provider Demographics
NPI:1124163761
Name:MATHEWS, EMILY MILLARD (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MILLARD
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9497
Mailing Address - Country:US
Mailing Address - Phone:802-462-3566
Mailing Address - Fax:
Practice Address - Street 1:219 S MAIN ST
Practice Address - Street 2:DEPARTMENT OF SPORTS MEDICINE
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1443
Practice Address - Country:US
Practice Address - Phone:802-443-5976
Practice Address - Fax:802-443-2094
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00001472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer