Provider Demographics
NPI:1841562402
Name:SCOTT, RACHEL D (LPN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 STEDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SCIOTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5476
Mailing Address - Country:US
Mailing Address - Phone:740-776-0541
Mailing Address - Fax:
Practice Address - Street 1:1028 STEDMAN AVE
Practice Address - Street 2:
Practice Address - City:SCIOTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45662-5476
Practice Address - Country:US
Practice Address - Phone:740-776-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH146663Medicaid