Provider Demographics
NPI:1871706861
Name:SNYDER, JEFFREY THOMAS (MS ATC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:OH
Mailing Address - Zip Code:43517-9384
Mailing Address - Country:US
Mailing Address - Phone:419-298-2156
Mailing Address - Fax:
Practice Address - Street 1:EDGERTON HIGH SCHOOL
Practice Address - Street 2:111 EAST RIVER STREET
Practice Address - City:EDGERTON
Practice Address - State:OH
Practice Address - Zip Code:43517
Practice Address - Country:US
Practice Address - Phone:419-298-2331
Practice Address - Fax:419-298-1322
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0007852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer