Individual
THEODORA SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT
Contact information
Practice address
640 MARY MCLEOD BETHUNE BLVD, DAYTONA BEACH, FL 32114-3211
(386) 481-2282
Mailing address
5400 S WILLIAMSON BLVD APT 6-204, PORT ORANGE, FL 32128-6550
(910) 934-2930
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2211
NC
2255A2300X
Athletic Trainer
Primary
AL5323
FL
Other
Enumeration date
02/06/2014
Last updated
02/12/2021
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