Provider Demographics
NPI:1679386080
Name:SCOTT, TRAVIS RAY
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:RAY
Last Name:SCOTT
Suffix:
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 1:16520 E 95TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8300
Mailing Address - Country:US
Mailing Address - Phone:539-525-4357
Mailing Address - Fax:
Practice Address - Street 1:16520 E 95TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8300
Practice Address - Country:US
Practice Address - Phone:539-525-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist