=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932361045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT BRAUD BCBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2008
-----------------------------------------------------
Last Update Date | 06/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 751 EAST GEORGIA STREET SUITE 100
-----------------------------------------------------
City | WOODRUFF
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-706-6835
-----------------------------------------------------
Fax | 864-476-0033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 751 EAST GEORGIA RD.
-----------------------------------------------------
City | WOODRUFF
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-706-6835
-----------------------------------------------------
Fax | 864-476-0033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225500000X
-----------------------------------------------------
Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
-----------------------------------------------------
License Number | BCBA 1-03-1237
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-03-1237
-----------------------------------------------------
License Number State |
-----------------------------------------------------