Provider Demographics
NPI:1710238522
Name:FLEET, DOUGLAS SCOTT (OTR/L)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:FLEET
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 1:235 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1051
Mailing Address - Country:US
Mailing Address - Phone:315-536-7447
Mailing Address - Fax:315-536-3281
Practice Address - Street 1:235 NORTH AVE
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1051
Practice Address - Country:US
Practice Address - Phone:315-536-7447
Practice Address - Fax:315-536-3281
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012607-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist