Theodora Scott, MS, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL5323 Issued in FL

Practice address

640 Mary McLeod Bethune Blvd
Daytona Beach, FL 32114-3211

Phone

(386) 481-2282

NPI assigned

Feb 6, 2014

Last updated

Feb 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Theodora Scott Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Winston-Salem State University

  dba WSSU Sports Medicine

  • Student Health Clinic/Center
  • Winston Salem, NC
  • NPI 1144649948
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1619391091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 S WILLIAMSON BLVD APT 6-204",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321286550",
            "telephone_number": "910-934-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 MARY MCLEOD BETHUNE BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143211",
            "telephone_number": "386-481-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "THEODORA",
        "credential": "MS, ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-06",
        "last_updated": "2021-02-12",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL5323",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "2211",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THEODORA",
            "last_name": "SCOTT",
            "credential": "MS, ATC, LAT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Athletic Trainer in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.