Provider Demographics
NPI:1639350481
Name:BUCK, SCOTT FARLEY (STATE LICENSE)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:FARLEY
Last Name:BUCK
Suffix:
Gender:M
Credentials:STATE LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 S BAGLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7149
Mailing Address - Country:US
Mailing Address - Phone:360-775-0867
Mailing Address - Fax:360-417-8161
Practice Address - Street 1:1053 S BAGLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7149
Practice Address - Country:US
Practice Address - Phone:360-775-0867
Practice Address - Fax:360-417-8161
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist