Healthcare Provider Details

I. General information

NPI: 1427229004
Provider Name (Legal Business Name): STEPHANIE SCRUGGS LICDC-CS, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE NELMS LICDC-CS, LMT

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MADISON AVE
COVINGTON KY
41011-2422
US

IV. Provider business mailing address

3021 VERNON PLACE SUITE 2
CINCINNATI OH
45219-2417
US

V. Phone/Fax

Practice location:
  • Phone: 859-491-6672
  • Fax:
Mailing address:
  • Phone: 513-541-7099
  • Fax: 513-541-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: