Provider Demographics
NPI:1629261326
Name:SCOTT, KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:BOOMS-SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:52477 PAPPY LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 BARCLAY CIR
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5815
Practice Address - Country:US
Practice Address - Phone:586-991-0801
Practice Address - Fax:586-991-0804
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist