Provider Demographics
NPI:1073676375
Name:SCOTT, ERICA LEA (OTR)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:SCHEMENAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 E 2ND ST
Mailing Address - Street 2:ESSENTIA HEALTH POLINSKY MEDICAL REHABILITATION CENTER
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1913
Mailing Address - Country:US
Mailing Address - Phone:218-786-5360
Mailing Address - Fax:
Practice Address - Street 1:530 E 2ND ST
Practice Address - Street 2:ESSENTIA HEALTH POLINSKY MEDICAL REHABILITATION CENTER
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1913
Practice Address - Country:US
Practice Address - Phone:218-786-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40881200Medicaid