Healthcare Provider Details

I. General information

NPI: 1104805027
Provider Name (Legal Business Name): W. SCOTT WOOD III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE DIVISION OF REHABILITATION SERVICES (117)
MARTINSBURG WV
25401-9990
US

IV. Provider business mailing address

47 CAMBRIDGE CT
MARTINSBURG WV
25401-0951
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax: 304-262-4842
Mailing address:
  • Phone: 304-263-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-0014
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: