Provider Demographics
NPI:1619376217
Name:ICE, STEVEN (LAT ATC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ICE
Suffix:
Gender:M
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 SE STARLITE DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2168
Mailing Address - Country:US
Mailing Address - Phone:785-608-4505
Mailing Address - Fax:
Practice Address - Street 1:1700 SW COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66621-0001
Practice Address - Country:US
Practice Address - Phone:785-670-1753
Practice Address - Fax:785-670-1091
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-000102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer