Healthcare Provider Details

I. General information

NPI: 1215272893
Provider Name (Legal Business Name): JONATHAN SCOTT LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CAPPELLETTI DR
DAMARISCOTTA ME
04543-4008
US

IV. Provider business mailing address

PO BOX 61
NEWCASTLE ME
04553-0061
US

V. Phone/Fax

Practice location:
  • Phone: 706-676-7708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT5932
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: