Provider Demographics
NPI:1043657265
Name:TONG, KEVIN M (AT, ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:TONG
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-4317
Mailing Address - Country:US
Mailing Address - Phone:419-785-4002
Mailing Address - Fax:
Practice Address - Street 1:400 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-4317
Practice Address - Country:US
Practice Address - Phone:419-785-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-13762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer