MEDICARE: AILEEN MICHELLE SCOGGINS

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	225700000X	Massage Therapist	0018043	CO

General Provider Information

NPI Number	:	1639666225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN MICHELLE SCOGGINS

Provider Business Mailing Address
First Line	:	1245 E LINCOLN AVE APT 622
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 E LINCOLN AVE APT 622
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4748
Country	:	US
Telephone Number	:	949-278-2479
Fax Number	:

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

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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