Healthcare Provider Details

I. General information

NPI: 1649195611
Provider Name (Legal Business Name): BRIAN SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 VALLEY VIEW DR
AFTON MI
49705-9500
US

IV. Provider business mailing address

3160 VALLEY VIEW DR
AFTON MI
49705-9500
US

V. Phone/Fax

Practice location:
  • Phone: 231-767-5465
  • Fax:
Mailing address:
  • Phone: 231-767-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberS300098465610
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: