Provider Demographics
NPI:1164244075
Name:SCOTT, MARIO CARNELL (DSP)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:CARNELL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 WADE WALK APT F
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-3415
Mailing Address - Country:US
Mailing Address - Phone:513-501-8763
Mailing Address - Fax:
Practice Address - Street 1:838 WADE WALK APT F
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-3415
Practice Address - Country:US
Practice Address - Phone:513-501-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care