Provider Demographics
NPI:1770027500
Name:SCOTT, MARLO
Entity Type:Individual
Prefix:MS
First Name:MARLO
Middle Name:
Last Name:SCOTT
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 1:3135 1ST AVE N
Mailing Address - Street 2:BOX 13613
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33730-9990
Mailing Address - Country:US
Mailing Address - Phone:855-427-4849
Mailing Address - Fax:
Practice Address - Street 1:3135 1ST AVE N
Practice Address - Street 2:13613
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33730-9990
Practice Address - Country:US
Practice Address - Phone:855-427-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL11837821744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management