Provider Demographics
NPI:1568680114
Name:SCROGGINA, HAZEL R
Entity Type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:R
Last Name:SCROGGINA
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 1:17 WAGON WHEEL CT
Mailing Address - Street 2:P. O. BOX 241613
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4160
Mailing Address - Country:US
Mailing Address - Phone:501-223-8211
Mailing Address - Fax:
Practice Address - Street 1:17 WAGON WHEEL CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4160
Practice Address - Country:US
Practice Address - Phone:501-223-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222Q00000X222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist