Provider Demographics
NPI:1316672306
Name:SCOTT, ANGELA THERESA I
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:THERESA
Last Name:SCOTT
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 VT ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05492-9541
Mailing Address - Country:US
Mailing Address - Phone:802-878-6658
Mailing Address - Fax:
Practice Address - Street 1:1378 VT ROUTE 109
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:VT
Practice Address - Zip Code:05492-9541
Practice Address - Country:US
Practice Address - Phone:802-878-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT164.0000257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist