Provider Demographics
NPI:1497454961
Name:SCOTT, MICHAELA RENEE (RBT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72-1017 MAKALEI DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8452
Mailing Address - Country:US
Mailing Address - Phone:540-222-1139
Mailing Address - Fax:
Practice Address - Street 1:72-1017 MAKALEI DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8452
Practice Address - Country:US
Practice Address - Phone:540-222-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-23-253167106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician