MEDICARE: MR. DAVID L. RUDLER L.I.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I-0009314	OH

General Provider Information

NPI Number	:	1528052743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID L. RUDLER L.I.S.W.

Provider Business Mailing Address
First Line	:	852 GROVE ST
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-1658
Country	:	US
Telephone Number	:	440-599-9074
Fax Number	:	440-599-9074

Provider Business Practice Location Address
First Line	:	852 GROVE ST
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-1658
Country	:	US
Telephone Number	:	440-599-9074
Fax Number	:	440-599-9074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/08/2007

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