Healthcare Provider Details

I. General information

NPI: 1184121394
Provider Name (Legal Business Name): CATHERINE JEAN SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 ANN ARBOR RD
JACKSON MI
49201-8801
US

IV. Provider business mailing address

6550 N SHORE DR
CLARKLAKE MI
49234-9003
US

V. Phone/Fax

Practice location:
  • Phone: 517-764-2000
  • Fax:
Mailing address:
  • Phone: 419-340-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: