MEDICARE: HOLLY ELIZABETH SCARGILL

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	:	1225613789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY ELIZABETH SCARGILL

Provider Business Mailing Address
First Line	:	4663 E WALKERTON RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4271
Country	:	US
Telephone Number	:	215-622-8935
Fax Number	:

Provider Business Practice Location Address
First Line	:	4663 E WALKERTON RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4271
Country	:	US
Telephone Number	:	215-622-8935
Fax Number	:

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

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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