Provider Demographics
NPI:1427392927
Name:BORIS, SCOTT M (OTR/L)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:BORIS
Suffix:
Gender:M
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 1:2005 SHANNON GRAY CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9183
Mailing Address - Country:US
Mailing Address - Phone:336-307-4729
Mailing Address - Fax:
Practice Address - Street 1:2005 SHANNON GRAY CT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9183
Practice Address - Country:US
Practice Address - Phone:336-307-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist