Provider Demographics
NPI:1306955273
Name:BREWSTER, KRISTIN S (OTR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:S
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:75 LAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9599
Mailing Address - Country:US
Mailing Address - Phone:802-879-0399
Mailing Address - Fax:
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-847-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist