Provider Demographics
NPI:1891188934
Name:CORSO, HAYLEY ROXANNE (AT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:ROXANNE
Last Name:CORSO
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NORTHVIEW PL
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1135
Mailing Address - Country:US
Mailing Address - Phone:419-602-7172
Mailing Address - Fax:
Practice Address - Street 1:39 NORTHVIEW PL
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1135
Practice Address - Country:US
Practice Address - Phone:419-602-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0044882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer