Provider Demographics
NPI:1780801845
Name:BOCKERSTETTE, THOMAS J
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BOCKERSTETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1973
Mailing Address - Country:US
Mailing Address - Phone:816-313-2800
Mailing Address - Fax:813-792-9819
Practice Address - Street 1:7521 RAVENSRIDGE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5502
Practice Address - Country:US
Practice Address - Phone:314-962-2100
Practice Address - Fax:314-962-1991
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO391237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist