Provider Demographics
NPI:1932722691
Name:SCOTT, TAKIA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:TAKIA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 SPRING LKS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3962
Mailing Address - Country:US
Mailing Address - Phone:832-722-8323
Mailing Address - Fax:
Practice Address - Street 1:2745 TOWN CENTER BLVD N
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2320
Practice Address - Country:US
Practice Address - Phone:832-722-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11578641744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty