Provider Demographics
NPI:1790813996
Name:ELKINTON, HEATHER ALICESON (MS, ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALICESON
Last Name:ELKINTON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 SW 49TH ST
Mailing Address - Street 2:APT. 92
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3027
Mailing Address - Country:US
Mailing Address - Phone:541-737-3212
Mailing Address - Fax:541-737-3135
Practice Address - Street 1:325 VALLEY FOOTBALL CTR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8544
Practice Address - Country:US
Practice Address - Phone:406-994-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer