Individual
MR. TRAVIS LEE SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D.
Contact information
Practice address
100 SOUTH BLISS AVE., TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
100 SOUTH BLISS AVE., TAHLEQUAH, OK 74464-2512
(918) 458-3100
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1110
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1110
STATE RD LICENSURE NUMBER
OK
Enumeration date
10/02/2006
Last updated
07/09/2007
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