MEDICARE: KERR SCOTT WHEATLEY CP

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	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1386817336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERR SCOTT WHEATLEY CP

Provider Business Mailing Address
First Line	:	411 BILLINGSLEY RD STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	407-377-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 BILLINGSLEY RD STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	407-377-7099
Fax Number	:

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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