Provider Demographics
NPI:1699742064
Name:DEGRAFF, SCOTT (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:DEGRAFF
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 SANCTUARY DR
Mailing Address - Street 2:APT. 307 B
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7889
Mailing Address - Country:US
Mailing Address - Phone:847-265-2135
Mailing Address - Fax:
Practice Address - Street 1:1000 FOOTBALL DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4829
Practice Address - Country:US
Practice Address - Phone:847-739-5405
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer