Healthcare Provider Details

I. General information

NPI: 1083227466
Provider Name (Legal Business Name): SYDNEY HOTZ ATC, LAT, NREMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W HINES HILL RD
HUDSON OH
44236-1032
US

IV. Provider business mailing address

129 W HINES HILL RD
HUDSON OH
44236-1032
US

V. Phone/Fax

Practice location:
  • Phone: 207-974-9129
  • Fax:
Mailing address:
  • Phone: 207-974-9129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: