Provider Demographics
NPI:1033642970
Name:PELTIER, CORINNE (MSED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:PELTIER
Suffix:
Gender:F
Credentials:MSED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13009 E GIBSON RD
Mailing Address - Street 2:APT Q230
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7348
Mailing Address - Country:US
Mailing Address - Phone:517-581-3535
Mailing Address - Fax:
Practice Address - Street 1:13009 E GIBSON RD
Practice Address - Street 2:APT Q230
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7348
Practice Address - Country:US
Practice Address - Phone:517-581-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1604032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer