Provider Demographics
NPI:1932798477
Name:KEPHART, TOKECA MARIE (ATC)
Entity Type:Individual
Prefix:MS
First Name:TOKECA
Middle Name:MARIE
Last Name:KEPHART
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 1:516 NILE KINNICK DR S
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-2076
Mailing Address - Country:US
Mailing Address - Phone:515-478-7171
Mailing Address - Fax:
Practice Address - Street 1:801 NILE KINNICK DR S
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-2024
Practice Address - Country:US
Practice Address - Phone:402-651-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0987892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer