Healthcare Provider Details

I. General information

NPI: 1053215632
Provider Name (Legal Business Name): RICHARD SIGGELOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SERVICEBERRY LN
BUCKHANNON WV
26201-3948
US

IV. Provider business mailing address

41 SERVICEBERRY LN
BUCKHANNON WV
26201-3948
US

V. Phone/Fax

Practice location:
  • Phone: 304-266-1832
  • Fax:
Mailing address:
  • Phone: 304-266-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: