Provider Demographics
NPI:1346612470
Name:SCOTT, ALISA D (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ALISA
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ALISA
Other - Middle Name:D
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:STUDIO121 121 NE B ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-787-1662
Mailing Address - Fax:
Practice Address - Street 1:STUDIO121 121 NE B ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-787-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist