Provider Demographics
NPI:1407020530
Name:STOTT, BENJAMIN (DAOM, LAC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:STOTT
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2758
Mailing Address - Country:US
Mailing Address - Phone:541-944-7355
Mailing Address - Fax:
Practice Address - Street 1:155 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2758
Practice Address - Country:US
Practice Address - Phone:541-944-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACF 2810171100000X
OR119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist