Provider Demographics
NPI:1639884406
Name:HARRELL, SCOTT FORD (LICENSED ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:FORD
Last Name:HARRELL
Suffix:
Gender:M
Credentials:LICENSED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2934
Mailing Address - Country:US
Mailing Address - Phone:817-335-1411
Mailing Address - Fax:817-335-1429
Practice Address - Street 1:1100 W CANNON ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2934
Practice Address - Country:US
Practice Address - Phone:817-335-1411
Practice Address - Fax:817-335-1429
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX444222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist