Healthcare Provider Details

I. General information

NPI: 1508043035
Provider Name (Legal Business Name): SCOTT MACLOWRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1558 SW NANCY WAY STE 103
BEND OR
97702-3216
US

IV. Provider business mailing address

1951 NW NEWPORT HILLS DR
BEND OR
97701-1469
US

V. Phone/Fax

Practice location:
  • Phone: 503-956-4114
  • Fax:
Mailing address:
  • Phone: 503-956-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13985
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: