1992189112 NPI number — MS. MOLLY ROCHELLE ECK MS, ATC

Table of content: MS. MOLLY ROCHELLE ECK MS, ATC (NPI 1992189112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992189112 NPI number — MS. MOLLY ROCHELLE ECK MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECK
Provider First Name:
MOLLY
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992189112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7677 YANKEE ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459-3475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-401-6400
Provider Business Mailing Address Fax Number:
937-401-6513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 HILLCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45320-8501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-456-1141
Provider Business Practice Location Address Fax Number:
937-456-1143
Provider Enumeration Date:
07/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT.004709 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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