Provider Demographics
NPI:1588012215
Name:CLOVER, HEATHER JEAN (ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:CLOVER
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:PO BOX 122
Mailing Address - Street 2:381 PINE STREET
Mailing Address - City:STRATTANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16258-0122
Mailing Address - Country:US
Mailing Address - Phone:814-227-6853
Mailing Address - Fax:
Practice Address - Street 1:381 PINE STREET
Practice Address - Street 2:
Practice Address - City:STRATTANVILLE
Practice Address - State:PA
Practice Address - Zip Code:16258-0122
Practice Address - Country:US
Practice Address - Phone:814-227-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer