Provider Demographics
NPI:1164290169
Name:SCOTT, KATIE MARIE (RADT-1)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 13TH STREET
Mailing Address - Street 2:WING B, 1ST FLOOR
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341
Mailing Address - Country:US
Mailing Address - Phone:209-381-6800
Mailing Address - Fax:209-725-3981
Practice Address - Street 1:301 E 13TH STREET
Practice Address - Street 2:WING B, 1ST FLOOR
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341
Practice Address - Country:US
Practice Address - Phone:209-381-6800
Practice Address - Fax:209-725-3981
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1531031023390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program