MEDICARE: MR. ANDRE 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	106S00000X	Behavior Technician	1487008587	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790263283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDRE SCOTT

Provider Business Mailing Address
First Line	:	955 TENNESSEE AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1027
Country	:	US
Telephone Number	:	513-437-2774
Fax Number	:	513-964-9812

Provider Business Practice Location Address
First Line	:	1108 KEMPER MEADOW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-4117
Country	:	US
Telephone Number	:	513-975-2027
Fax Number	:	513-964-9812

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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