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General NPI Number Information
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NPI Number | 1225287618
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Entity Type | Individual
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Provider Name | STEVEN M KOCH ATC
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Gender | Male
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY CIR
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City | MACOMB
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State | IL
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Zip | 61455-1367
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Country | US
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Telephone | 309-298-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 553 RIVER RUN DR
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City | MACOMB
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State | IL
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Zip | 61455-1173
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Country | US
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Telephone | 309-333-2860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096002463
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License Number State | IL
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