Provider Demographics
NPI:1083085922
Name:WILLIAMS, SCOTT (CPO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RAINTREE CIR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4901
Mailing Address - Country:US
Mailing Address - Phone:405-471-2088
Mailing Address - Fax:
Practice Address - Street 1:1111 RAINTREE CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4901
Practice Address - Country:US
Practice Address - Phone:405-471-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1525222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist