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NPI Code Detail

MEDICARE: MRS. HEATHER MARIE CHERNYSHOV MS, ATC, NCTMB

MEDICARE: MRS. HEATHER MARIE CHERNYSHOV MS, ATC, NCTMB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer104-0000087VT

General Provider Information

NPI Number : 1124121454
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER MARIE CHERNYSHOV MS, ATC, NCTMB
Provider Business Mailing Address
First Line : 115 WELLNESS DR
Second Line :
City : WILLISTON
State : VT
Zip : 05495-2088
Country : US
Telephone Number : 802-860-1358
Fax Number :
Provider Business Practice Location Address
First Line : 115 WELLNESS DR
Second Line :
City : WILLISTON
State : VT
Zip : 05495-2088
Country : US
Telephone Number : 802-860-1358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 10/15/2008

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