Provider Demographics
NPI:1992189112
Name:ECK, MOLLY ROCHELLE (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ROCHELLE
Last Name:ECK
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7677 YANKEE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3475
Mailing Address - Country:US
Mailing Address - Phone:937-401-6400
Mailing Address - Fax:937-401-6513
Practice Address - Street 1:600 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8501
Practice Address - Country:US
Practice Address - Phone:937-456-1141
Practice Address - Fax:937-456-1143
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0047092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer