Provider Demographics
NPI:1912281049
Name:SCOTT, SHANNON M
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
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 1:111 W TELEGRAPH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4266
Mailing Address - Country:US
Mailing Address - Phone:775-885-7790
Mailing Address - Fax:775-885-7791
Practice Address - Street 1:111 WEST TELEGRAPH STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3113
Practice Address - Country:US
Practice Address - Phone:775-885-7790
Practice Address - Fax:775-885-7791
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner