Provider Demographics
NPI:1689669582
Name:VANDEN AKKER, KEVIN SCOTT (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:VANDEN AKKER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:SCOTT
Other - Last Name:VANDEN AKKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2303 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1237
Mailing Address - Country:US
Mailing Address - Phone:260-359-4287
Mailing Address - Fax:260-359-4108
Practice Address - Street 1:2303 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1237
Practice Address - Country:US
Practice Address - Phone:260-359-4287
Practice Address - Fax:260-359-4108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000025A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer