Healthcare Provider Details

I. General information

NPI: 1912050170
Provider Name (Legal Business Name): MARCIA SCOTT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 WYOMING BLVD SE SANDIA BASE ES
ALBUQUERQUE NM
87116-1151
US

IV. Provider business mailing address

21001 WYOMING BLVD SE SANDIA BASE ES
ALBUQUERQUE NM
87116-1151
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-4356
  • Fax:
Mailing address:
  • Phone: 505-268-4356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: