Brandon Tyler Stott, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A160808361 Issued in WA

Practice address

17023 11TH Ave NE
Arlington, WA 98223

Phone

(360) 652-4505

NPI assigned

May 10, 2019

Last updated

Jan 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1790341113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 188TH STREET NE",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "98223",
            "telephone_number": "425-346-8067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17023 11TH AVE NE",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "98223",
            "telephone_number": "360-652-4505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10511 19th Avenue SE",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982084279",
            "country_code": "US",
            "telephone_number": "425-357-8885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOTT",
        "first_name": "BRANDON",
        "middle_name": "TYLER",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-10",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WA",
            "license": "A160808361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Arlington, WA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; 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.