MEDICARE: MS. SCOTTIE VISSER LMT, CLT

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	174400000X	Specialist	MAS 9044	SC

General Provider Information

NPI Number	:	1790162329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SCOTTIE VISSER LMT, CLT

Provider Business Mailing Address
First Line	:	130 RIVER LANDING DR
Second Line	:	SUITE 1-D
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7400
Country	:	US
Telephone Number	:	843-754-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 RIVER LANDING DR
Second Line	:	SUITE 1-D
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7400
Country	:	US
Telephone Number	:	843-754-5898
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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