Provider Demographics
NPI:1679615223
Name:SCOTT, COREY DANIEL (LMP)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:DANIEL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:217 N MERIDIAN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-8647
Mailing Address - Country:US
Mailing Address - Phone:253-770-2245
Mailing Address - Fax:253-770-2249
Practice Address - Street 1:217 N MERIDIAN
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8647
Practice Address - Country:US
Practice Address - Phone:253-770-2245
Practice Address - Fax:253-770-2249
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist