MEDICARE: SCOTTIE ANN MCCLURE

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	225200000X	Physical Therapy Assistant	934	NC

General Provider Information

NPI Number	:	1144426743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTTIE ANN MCCLURE

Provider Business Mailing Address
First Line	:	4555 WATER OAK DR
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8058
Country	:	US
Telephone Number	:	803-831-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 WATER OAK DR
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8058
Country	:	US
Telephone Number	:	803-831-1006
Fax Number	:

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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Directions to “ SCOTTIE ANN MCCLURE ” Practice Location

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