Healthcare Provider Details

I. General information

NPI: 1659294387
Provider Name (Legal Business Name): MARTINA TIANA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SAUNDERS AVE
BRIDGEPORT CT
06606-3934
US

IV. Provider business mailing address

525 SAUNDERS AVE
BRIDGEPORT CT
06606-3934
US

V. Phone/Fax

Practice location:
  • Phone: 727-276-6548
  • Fax:
Mailing address:
  • Phone: 727-276-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number88723
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: