Individual provider · NPI-1

Heather B Elliott, ATC

Specialist/Technologist, Athletic Trainer · Corvallis, OR

NPI number1902166853
StatusActive
Last updated in NPPESOct 22, 2024

Details

NPI
1902166853
Entity type
Individual (NPI-1)
Name
Heather B Elliott
Credential
ATC
Sex
Female
Sole proprietor
Yes
Enumeration date
May 25, 2012
Certification date
Oct 22, 2024
Last updated
Oct 22, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer–UTYes
2255A2300X Specialist/Technologist, Athletic TrainerAT10193631OR

Practice location

845 Sw 30th St Ste 100
Corvallis, OR 97331-8629

Phone 541-768-7700

Mailing address

3917 Bear Hollow Rd
Joelton, TN 37080-8912

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