Basic Information
| Provider Information | |||||||||
| NPI: | 1154944866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRESCOTT | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | TRAVIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4433 MILLER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485071123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107330280 | ||||||||
| FaxNumber: | 8107330270 | ||||||||
| Practice Location | |||||||||
| Address1: | 4433 MILLER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485071123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107330280 | ||||||||
| FaxNumber: | 8107330270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2020 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224P00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist | 222Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist |
No ID Information.