Individual
ASHLEY HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
15690 SE HEIDI LN, DAMASCUS, OR 97089-2752
(503) 459-1811
Mailing address
15690 SE HEIDI LN, DAMASCUS, OR 97089-2752
(503) 459-1811
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10154081
OR
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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