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NPI Code Detail

MEDICARE: BRADY SCOTT ISMOND

MEDICARE: BRADY SCOTT ISMOND
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
1106S00000XBehavior TechnicianRBT-21-165741TX

General Provider Information

NPI Number : 1962085365
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADY SCOTT ISMOND
Provider Business Mailing Address
First Line : 7160 PRESTON RD STE 200
Second Line :
City : PLANO
State : TX
Zip : 75024-3283
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7160 PRESTON RD STE 200
Second Line :
City : PLANO
State : TX
Zip : 75024-3283
Country : US
Telephone Number : 972-769-5938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2021
Last Update Date : 05/03/2021

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Directions to “ BRADY SCOTT ISMOND ” Practice Location

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