MEDICARE: MS. KIMBERLY SCOTT

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	225200000X	Physical Therapy Assistant	A3311	MD

General Provider Information

NPI Number	:	1669904447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY SCOTT

Provider Business Mailing Address
First Line	:	2921 EXCELSIOR SPRINGS CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 EXCELSIOR SPRINGS CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7614
Country	:	US
Telephone Number	:	410-707-6193
Fax Number	:

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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