Healthcare Provider Details

I. General information

NPI: 1700017100
Provider Name (Legal Business Name): KYLE R. SCOTT CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 NE 2ND ST SUITE 204
CORVALLIS OR
97330-6230
US

IV. Provider business mailing address

2292 NW KINGS BLVD.
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 541-752-9034
  • Fax: 541-752-0216
Mailing address:
  • Phone: 541-752-9034
  • Fax: 541-752-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: