1467077321 NPI number — CHELSEA SCOTT M.ED., ATC

Table of content: CHELSEA SCOTT M.ED., ATC (NPI 1467077321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467077321 NPI number — CHELSEA SCOTT M.ED., ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
CHELSEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEGGE
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467077321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6956 TOWNSHIP ROAD 48
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAWSON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45881-9622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 TIGER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BALTIMORE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45872-8720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-674-9229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT0055425 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)