Provider Demographics
NPI:1205086709
Name:PURCELL, STEVEN B (MS, AT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:B
Last Name:PURCELL
Suffix:
Gender:M
Credentials:MS, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 WESSEL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4313
Mailing Address - Country:US
Mailing Address - Phone:314-805-8117
Mailing Address - Fax:
Practice Address - Street 1:1 BLACK AND GOLD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2091
Practice Address - Country:US
Practice Address - Phone:314-805-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0037312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer