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General NPI Number Information
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NPI Number | 1609775238
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Entity Type | Individual
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Provider Name | JONATHAN DAVID SCRUGGS ASSOCIATE'S DEGREE
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Gender | Male
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 307 FEDERAL ST
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City | BLUEFIELD
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State | WV
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Zip | 24701-3063
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Country | US
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Telephone | 304-323-3069
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Fax | 304-324-7946
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Provider Business Mailing Address
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Address Line | 307 FEDERAL ST 738 MERCER ST PRINCETON, WV
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City | BLUEFIELD
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State | WV
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Zip | 24701-3063
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Country | US
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Telephone | 304-323-3069
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Fax | 304-324-7946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | C2643
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License Number State | WV
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