Provider Demographics
NPI:1568716801
Name:SCOTT, SUSAN S
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:103 W. FREMONT AVE. #201
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-2009
Mailing Address - Country:US
Mailing Address - Phone:509-697-7859
Mailing Address - Fax:509-697-9770
Practice Address - Street 1:104 N 4TH AVE.
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2636
Practice Address - Country:US
Practice Address - Phone:509-573-2045
Practice Address - Fax:509-573-2082
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist