Healthcare Provider Details

I. General information

NPI: 1396978995
Provider Name (Legal Business Name): MARK SCOTT LCPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 08/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BEE CAVES RD
AUSTIN TX
78746-5598
US

IV. Provider business mailing address

3001 BEE CAVES RD
AUSTIN TX
78746-5598
US

V. Phone/Fax

Practice location:
  • Phone: 512-389-3210
  • Fax:
Mailing address:
  • Phone: 512-389-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: