MEDICARE: MR. SCOTT FORD HARRELL LICENSED ORTHOTIST

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	222Z00000X	Orthotist	444	TX

General Provider Information

NPI Number	:	1639884406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT FORD HARRELL LICENSED ORTHOTIST

Provider Business Mailing Address
First Line	:	1100 W CANNON ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2934
Country	:	US
Telephone Number	:	817-335-1411
Fax Number	:	817-335-1429

Provider Business Practice Location Address
First Line	:	1100 W CANNON ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2934
Country	:	US
Telephone Number	:	817-335-1411
Fax Number	:	817-335-1429

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

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	01/17/2023

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Directions to “ MR. SCOTT FORD HARRELL LICENSED ORTHOTIST” Practice Location

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