Provider Demographics
NPI:1225575475
Name:CORRIVEAU, HEATHER (ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ISAAC FRYE HWY
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03086-5813
Mailing Address - Country:US
Mailing Address - Phone:603-654-2391
Mailing Address - Fax:
Practice Address - Street 1:222 ISAAC FRYE HWY
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NH
Practice Address - Zip Code:03086-5804
Practice Address - Country:US
Practice Address - Phone:603-654-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12842255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer