Provider Demographics
NPI:1417083676
Name:SCOTT, ERIC ANDREW (LATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANDREW
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1318
Mailing Address - Country:US
Mailing Address - Phone:508-321-1151
Mailing Address - Fax:
Practice Address - Street 1:65 E UNION ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1761
Practice Address - Country:US
Practice Address - Phone:508-881-0177
Practice Address - Fax:508-881-0192
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer