Provider Demographics
NPI:1386618981
Name:PEPPLER, MICHAEL A (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:PEPPLER
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 1:113 SUNSET PT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1031
Mailing Address - Country:US
Mailing Address - Phone:618-664-0197
Mailing Address - Fax:
Practice Address - Street 1:315 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1145
Practice Address - Country:US
Practice Address - Phone:618-664-6629
Practice Address - Fax:618-664-1060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer