Provider Demographics
NPI:1720682495
Name:SCOTT, WALTER WILLIAM II
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:WILLIAM
Last Name:SCOTT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6358
Mailing Address - Country:US
Mailing Address - Phone:405-227-5807
Mailing Address - Fax:
Practice Address - Street 1:2601 SPENCER RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3649
Practice Address - Country:US
Practice Address - Phone:405-427-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician