Provider Demographics
NPI:1083739064
Name:SCOTT, STEPHANIE (OTR-L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 TRENT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7527
Mailing Address - Country:US
Mailing Address - Phone:252-670-5485
Mailing Address - Fax:252-637-9184
Practice Address - Street 1:4713 TRENT RIVER DR
Practice Address - Street 2:
Practice Address - City:TRENT WOODS
Practice Address - State:NC
Practice Address - Zip Code:28562-7527
Practice Address - Country:US
Practice Address - Phone:252-670-5485
Practice Address - Fax:252-637-9184
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301930Medicaid