Provider Demographics
NPI:1508199126
Name:SCOTT, POOK PRAWATCHAROENWIT (PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:POOK
Middle Name:PRAWATCHAROENWIT
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 E JEANINE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8114
Mailing Address - Country:US
Mailing Address - Phone:360-536-0436
Mailing Address - Fax:
Practice Address - Street 1:5830 E JEANINE LN
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8114
Practice Address - Country:US
Practice Address - Phone:360-536-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60059379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist