Provider Demographics
NPI:1427596204
Name:BLATTLER, COREY (AT)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:
Last Name:BLATTLER
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 TULLYMORE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8401
Mailing Address - Country:US
Mailing Address - Phone:614-873-0459
Mailing Address - Fax:614-873-1492
Practice Address - Street 1:7245 TULLYMORE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8401
Practice Address - Country:US
Practice Address - Phone:614-873-0459
Practice Address - Fax:614-873-1492
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0035622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer