Healthcare Provider Details

I. General information

NPI: 1972914661
Provider Name (Legal Business Name): CARLY SCOTT LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 7TH ST
MYRTLE POINT OR
97458-1124
US

IV. Provider business mailing address

835 6TH ST
MYRTLE POINT OR
97458-1209
US

V. Phone/Fax

Practice location:
  • Phone: 541-290-9993
  • Fax:
Mailing address:
  • Phone: 541-290-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23689
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: