Healthcare Provider Details

I. General information

NPI: 1194794131
Provider Name (Legal Business Name): KAREN E MARROCCO ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W AVON RD SUITE 202
AVON CT
06001-3680
US

IV. Provider business mailing address

54 W AVON RD SUITE 202
AVON CT
06001-3680
US

V. Phone/Fax

Practice location:
  • Phone: 860-675-0357
  • Fax: 860-675-0358
Mailing address:
  • Phone: 860-675-0357
  • Fax: 860-675-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000166
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: