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General NPI Number Information
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NPI Number | 1366769754
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Entity Type | Individual
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Provider Name | ERIC M. AHONEN ATC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 3915 30TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-1957
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Country | US
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Telephone | 224-717-6666
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Fax | 262-657-7190
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Provider Business Mailing Address
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Address Line | 3915 30TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-1957
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Country | US
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Telephone | 224-717-6666
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Fax | 262-657-7190
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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 | 1062-39
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License Number State | WI
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