MEDICARE: SCOTT ANTILLA M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171R00000X	Interpreter

General Provider Information

NPI Number	:	1023553054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ANTILLA M.A.

Provider Business Mailing Address
First Line	:	400 LITCHFIELD AVE SW
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-3242
Country	:	US
Telephone Number	:	320-214-1234
Fax Number	:	320-214-1235

Provider Business Practice Location Address
First Line	:	400 LITCHFIELD AVE SW
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-3242
Country	:	US
Telephone Number	:	320-214-1234
Fax Number	:	320-214-1235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	03/15/2026

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Directions to “ SCOTT ANTILLA M.A.” Practice Location

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