Provider Demographics
NPI:1053439240
Name:SCOTT, VICKI L SR (MS, CTRS)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:SCOTT
Suffix:SR
Gender:F
Credentials:MS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7158 HALIBUT DR
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:IN
Mailing Address - Zip Code:46164-9539
Mailing Address - Country:US
Mailing Address - Phone:317-355-3843
Mailing Address - Fax:317-351-5476
Practice Address - Street 1:1500 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3027
Practice Address - Country:US
Practice Address - Phone:317-355-3843
Practice Address - Fax:317-351-5476
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist