Provider Demographics
NPI:1588681514
Name:HEWIG, KRISTEN NICOLE (ATC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:HEWIG
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 1:25 FIELDSTONE TER
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3652
Mailing Address - Country:US
Mailing Address - Phone:203-258-7566
Mailing Address - Fax:
Practice Address - Street 1:636 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4408
Practice Address - Country:US
Practice Address - Phone:203-934-2057
Practice Address - Fax:203-934-6659
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer