Provider Demographics
NPI:1538131271
Name:ANDERSON, SCOTT ALAN (ATC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73019-1018
Mailing Address - Country:US
Mailing Address - Phone:405-325-8332
Mailing Address - Fax:
Practice Address - Street 1:180 W BROOKS ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-1018
Practice Address - Country:US
Practice Address - Phone:405-325-8332
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist