MEDICARE: NICOLE ELIZABETH 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		LA

General Provider Information

NPI Number	:	1609726553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ELIZABETH SCOTT

Provider Business Mailing Address
First Line	:	350 FAIRWAY DRIVE
Second Line	:	SUITE: 101
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	11607 SOUTHFORK AVE BLDG B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5220
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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