MEDICARE: MR. MICHAEL ANTHONY SCOCOS SP

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	235Z00000X	Speech-Language Pathologist	SP-1787	OH

General Provider Information

NPI Number	:	1841293073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY SCOCOS SP

Provider Business Mailing Address
First Line	:	134 SCENIC VIEW DR
Second Line	:
City	:	COPLEY
State	:	OH
Zip	:	44321-1343
Country	:	US
Telephone Number	:	330-666-3980
Fax Number	:	330-665-5460

Provider Business Practice Location Address
First Line	:	134 SCENIC VIEW DR
Second Line	:
City	:	COPLEY
State	:	OH
Zip	:	44321-1343
Country	:	US
Telephone Number	:	330-666-3980
Fax Number	:	330-665-5460

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. MICHAEL ANTHONY SCOCOS SP” Practice Location

Language	Start Address	Practice Location

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