Provider Demographics
NPI:1679644231
Name:WITTE, SCOTT RAYMOND (MA, ATC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RAYMOND
Last Name:WITTE
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SOUTH DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4935
Mailing Address - Country:US
Mailing Address - Phone:701-237-4371
Mailing Address - Fax:
Practice Address - Street 1:1840 15TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3824
Practice Address - Country:US
Practice Address - Phone:701-446-2049
Practice Address - Fax:701-446-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND266-032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer