Provider Demographics
NPI:1629385125
Name:YADEN, SCOTT (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:YADEN
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13319 STEPPING STONE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5189
Mailing Address - Country:US
Mailing Address - Phone:502-599-3426
Mailing Address - Fax:502-618-0591
Practice Address - Street 1:13319 STEPPING STONE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:502-599-3426
Practice Address - Fax:502-618-0591
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005045A225X00000X
KYR4562225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100426080Medicaid