Provider Demographics
NPI:1194854612
Name:SCOTT, MICHELLE HERNANDEZ (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HERNANDEZ
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MOONSHADOW WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2619
Mailing Address - Country:US
Mailing Address - Phone:678-574-7599
Mailing Address - Fax:
Practice Address - Street 1:42 MOONSHADOW WAY
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2619
Practice Address - Country:US
Practice Address - Phone:678-574-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0012832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer