Provider Demographics
NPI:1083223416
Name:VAN SCOTER, MARI-LEE L
Entity Type:Individual
Prefix:
First Name:MARI-LEE
Middle Name:L
Last Name:VAN SCOTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 QUEENS WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1732
Mailing Address - Country:US
Mailing Address - Phone:315-882-5531
Mailing Address - Fax:
Practice Address - Street 1:32 QUEENS WAY APT 1
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1732
Practice Address - Country:US
Practice Address - Phone:315-882-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management