Provider Demographics
NPI:1912969429
Name:BUDDELMEYER, SCOTT MICHAEL (ATC, EMT-B)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:BUDDELMEYER
Suffix:
Gender:M
Credentials:ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:HOLGATE
Mailing Address - State:OH
Mailing Address - Zip Code:43527-9806
Mailing Address - Country:US
Mailing Address - Phone:419-264-0339
Mailing Address - Fax:
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2440
Practice Address - Country:US
Practice Address - Phone:419-783-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0220512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer