Healthcare Provider Details

I. General information

NPI: 1154944866
Provider Name (Legal Business Name): CLAYTON TRAVIS PRESCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 MILLER RD
FLINT MI
48507-1123
US

IV. Provider business mailing address

4433 MILLER RD
FLINT MI
48507-1123
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-0280
  • Fax: 810-733-0270
Mailing address:
  • Phone: 810-733-0280
  • Fax: 810-733-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: