Provider Demographics
NPI:1437605987
Name:FORTIN, TRISHA (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:
Last Name:FORTIN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1777
Mailing Address - Country:US
Mailing Address - Phone:508-804-6900
Mailing Address - Fax:
Practice Address - Street 1:2 PARK CENTRAL DR
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1777
Practice Address - Country:US
Practice Address - Phone:508-804-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT14069247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other