Provider Demographics
NPI:1033781364
Name:SCOTT, ZACHARY (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-3278
Mailing Address - Country:US
Mailing Address - Phone:423-903-1214
Mailing Address - Fax:
Practice Address - Street 1:2255 CANDIES LN NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2661
Practice Address - Country:US
Practice Address - Phone:423-472-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist