MEDICARE: TRESA L SCOTCH MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA 12336	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093957243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRESA L SCOTCH MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1355 LAKEVIEW DR
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3047
Country	:	US
Telephone Number	:	386-244-9519
Fax Number	:

Provider Business Practice Location Address
First Line	:	2765 REBECCA LN STE 2
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8326
Country	:	US
Telephone Number	:	386-244-9519
Fax Number	:	386-873-4781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	09/06/2021

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