MEDICARE: SCOTT CARLIN

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	225100000X	Physical Therapist	5295	OK

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	:	1811424989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT CARLIN

Provider Business Mailing Address
First Line	:	1624 MIDTOWN PL STE B
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6347
Country	:	US
Telephone Number	:	405-246-9355
Fax Number	:	405-246-9357

Provider Business Practice Location Address
First Line	:	1624 MIDTOWN PL STE B
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6347
Country	:	US
Telephone Number	:	405-246-9355
Fax Number	:	405-246-9357

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

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	03/27/2018

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Directions to “ SCOTT CARLIN ” Practice Location

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