MEDICARE: WILLIAM SCOTT MCCALL LMBT

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	225700000X	Massage Therapist	12356	NC

General Provider Information

NPI Number	:	1114375789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SCOTT MCCALL LMBT

Provider Business Mailing Address
First Line	:	613 BARKSDALE RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-3124
Country	:	US
Telephone Number	:	704-622-8844
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 PINE GROVE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5136
Country	:	US
Telephone Number	:	704-622-8844
Fax Number	:

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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