Healthcare Provider Details

I. General information

NPI: 1871706861
Provider Name (Legal Business Name): JEFFREY THOMAS SNYDER M.S. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDGERTON HIGH SCHOOL 111 EAST RIVER STREET
EDGERTON OH
43517
US

IV. Provider business mailing address

127 MAPLE LN
EDGERTON OH
43517-9384
US

V. Phone/Fax

Practice location:
  • Phone: 419-298-2331
  • Fax: 419-298-1322
Mailing address:
  • Phone: 419-298-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 000785
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: