Provider Demographics
NPI:1285927947
Name:SCOTT, JESSICA J (MT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 10TH AVE FRNT
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2811
Mailing Address - Country:US
Mailing Address - Phone:808-489-8888
Mailing Address - Fax:
Practice Address - Street 1:677 ALA MOANA BLVD STE 605
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5418
Practice Address - Country:US
Practice Address - Phone:808-489-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT8467225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist