Provider Demographics
NPI:1790162329
Name:VISSER, SCOTTIE (LMT, CLT)
Entity Type:Individual
Prefix:MS
First Name:SCOTTIE
Middle Name:
Last Name:VISSER
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RIVER LANDING DR
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7400
Mailing Address - Country:US
Mailing Address - Phone:843-754-5898
Mailing Address - Fax:
Practice Address - Street 1:130 RIVER LANDING DR
Practice Address - Street 2:SUITE 1-D
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7400
Practice Address - Country:US
Practice Address - Phone:843-754-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS 9044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist