Provider Demographics
NPI:1386095073
Name:SCOTT, TABATHA M (AIDE)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 MOUNT PLEASANT RD APT 7
Mailing Address - Street 2:
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-2797
Mailing Address - Country:US
Mailing Address - Phone:903-219-0986
Mailing Address - Fax:
Practice Address - Street 1:2823 COUNTY ROAD 1247
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:TX
Practice Address - Zip Code:75436-5113
Practice Address - Country:US
Practice Address - Phone:903-219-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide