Provider Demographics
NPI:1174048904
Name:TREBILCOCK, RICHELLE (LAT)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:TREBILCOCK
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1309
Mailing Address - Country:US
Mailing Address - Phone:602-316-8154
Mailing Address - Fax:
Practice Address - Street 1:302 W MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4306
Practice Address - Country:US
Practice Address - Phone:860-679-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer