Provider Demographics
NPI:1043355696
Name:FRECHETTE, JEFFREY C (ATC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:FRECHETTE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HB 6083
Practice Address - Street 2:DARTMOUTH COLLEGE
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-646-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer