Provider Demographics
NPI:1700029550
Name:SCOTT, JAMIE L (LAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LOM, LAC
Mailing Address - Street 1:4951 CATHARINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2007
Mailing Address - Country:US
Mailing Address - Phone:512-506-1608
Mailing Address - Fax:
Practice Address - Street 1:2012 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5655
Practice Address - Country:US
Practice Address - Phone:267-227-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00147100171100000X
PAOM126171100000X
TX1079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist