Healthcare Provider Details

I. General information

NPI: 1790905958
Provider Name (Legal Business Name): SCOTT JAMES PEPPEL ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 DUFF STREET KENYON ATHLETIC CENTER
GAMBIER OH
43022
US

IV. Provider business mailing address

601 FAIRLAND DR
SUNBURY OH
43074-8020
US

V. Phone/Fax

Practice location:
  • Phone: 740-427-5553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-1894
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: