Provider Demographics
NPI:1487305330
Name:SCOTT, ELEANORE JANE (MT-BC)
Entity type:Individual
Prefix:
First Name:ELEANORE
Middle Name:JANE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SLEEPY HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:TAYLOR LAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4716
Mailing Address - Country:US
Mailing Address - Phone:832-425-4637
Mailing Address - Fax:
Practice Address - Street 1:222 SLEEPY HOLLOW CT
Practice Address - Street 2:
Practice Address - City:TAYLOR LAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77586-4716
Practice Address - Country:US
Practice Address - Phone:832-425-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16515225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist