Provider Demographics
NPI:1841978780
Name:SCOTT, TRACY LEE (DAOM, LAC, LMT)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DAOM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10013 N 165TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5214
Mailing Address - Country:US
Mailing Address - Phone:918-519-7388
Mailing Address - Fax:
Practice Address - Street 1:435 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3208
Practice Address - Country:US
Practice Address - Phone:918-519-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC164698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty