MEDICARE: ANAMARIA CELESTE SCOTT

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205661147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAMARIA CELESTE SCOTT

Provider Business Mailing Address
First Line	:	465 E AVENUE C
Second Line	:
City	:	WENDELL
State	:	ID
Zip	:	83355-5315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 E MAIN ST STE 7
Second Line	:
City	:	JEROME
State	:	ID
Zip	:	83338-2333
Country	:	US
Telephone Number	:	208-886-0534
Fax Number	:

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

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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Directions to “ ANAMARIA CELESTE SCOTT ” Practice Location

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