Provider Demographics
NPI:1871118414
Name:SCOTT, STACEY E (LMT, CLT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:E
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-1293
Mailing Address - Country:US
Mailing Address - Phone:205-500-1115
Mailing Address - Fax:
Practice Address - Street 1:201 BEACON PKWY W STE 110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3129
Practice Address - Country:US
Practice Address - Phone:205-500-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3580225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist