Provider Demographics
NPI:1700017100
Name:SCOTT, KYLE R (CO)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 NW KINGS BLVD.
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-752-9034
Mailing Address - Fax:541-752-0216
Practice Address - Street 1:1128 NE 2ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6230
Practice Address - Country:US
Practice Address - Phone:541-752-9034
Practice Address - Fax:541-752-0216
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist