Provider Demographics
NPI:1215589668
Name:SCOTT, SAMANTHA ASHLEY (ATC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ASHLEY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S GREENWOOD LN UNIT 2172
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:NY
Mailing Address - Zip Code:12015-2706
Mailing Address - Country:US
Mailing Address - Phone:518-860-4265
Mailing Address - Fax:
Practice Address - Street 1:25 S GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:NY
Practice Address - Zip Code:12015-2706
Practice Address - Country:US
Practice Address - Phone:518-860-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer