Healthcare Provider Details

I. General information

NPI: 1699787465
Provider Name (Legal Business Name): CARL M SKOLL L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 AVENUE K SE
WINTER HAVEN FL
33880-4215
US

IV. Provider business mailing address

589 AVENUE K SE
WINTER HAVEN FL
33880-4215
US

V. Phone/Fax

Practice location:
  • Phone: 863-651-4263
  • Fax:
Mailing address:
  • Phone: 863-651-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA0024947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: