Provider Demographics
NPI:1932593019
Name:KUCHENBERG, MARINA NICOLE (ATC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:NICOLE
Last Name:KUCHENBERG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 GOLDIE LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-9129
Mailing Address - Country:US
Mailing Address - Phone:317-496-8978
Mailing Address - Fax:
Practice Address - Street 1:8390 GOLDIE LN
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-9129
Practice Address - Country:US
Practice Address - Phone:317-496-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer