Provider Demographics
NPI:1790905958
Name:PEPPEL, SCOTT JAMES (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAMES
Last Name:PEPPEL
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FAIRLAND DR
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 DUFF STREET
Practice Address - Street 2:KENYON ATHLETIC CENTER
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022
Practice Address - Country:US
Practice Address - Phone:740-427-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-18942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer