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General NPI Number Information
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NPI Number | 1942321864
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Entity Type | Individual
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Provider Name | SCOTT EDWARD MAREMA MS, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1900 W PINE AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-1961
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Country | US
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Telephone | 208-888-4905
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Fax | 208-888-5273
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Provider Business Mailing Address
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Address Line | 456 N KNOX AVE
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City | STAR
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State | ID
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Zip | 83669-5293
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Country | US
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Telephone | 208-922-8799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-172
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License Number State | ID
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