Provider Demographics
NPI:1295034254
Name:SOTO, SCARLETT MARY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SCARLETT
Middle Name:MARY
Last Name:SOTO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2556
Mailing Address - Country:US
Mailing Address - Phone:541-523-4578
Mailing Address - Fax:
Practice Address - Street 1:2419 7TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2522
Practice Address - Country:US
Practice Address - Phone:541-523-4578
Practice Address - Fax:541-523-4578
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4341225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist