Provider Demographics
NPI:1003169251
Name:SCOTT, KIMBERLY EVETTE (COTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EVETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SCHUYLER ST
Mailing Address - Street 2:APARTMENT 12
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7536
Mailing Address - Country:US
Mailing Address - Phone:716-483-6098
Mailing Address - Fax:
Practice Address - Street 1:210 SCHUYLER ST
Practice Address - Street 2:APARTMENT 12
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7536
Practice Address - Country:US
Practice Address - Phone:716-483-6098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008180-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator