Provider Demographics
NPI:1477296044
Name:SCOTLAND, TASHA
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:SCOTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4919
Mailing Address - Country:US
Mailing Address - Phone:516-932-5569
Mailing Address - Fax:516-932-7360
Practice Address - Street 1:1069 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4919
Practice Address - Country:US
Practice Address - Phone:516-932-5569
Practice Address - Fax:516-932-7360
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300-331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist