Provider Demographics
NPI:1730478751
Name:HOMER, SCOTT L (OTR/L)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:HOMER
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 1:823 MEDWAY EARLTON RD
Mailing Address - Street 2:
Mailing Address - City:EARLTON
Mailing Address - State:NY
Mailing Address - Zip Code:12058-4101
Mailing Address - Country:US
Mailing Address - Phone:518-346-2397
Mailing Address - Fax:
Practice Address - Street 1:823 MEDWAY EARLTON RD
Practice Address - Street 2:
Practice Address - City:EARLTON
Practice Address - State:NY
Practice Address - Zip Code:12058-4101
Practice Address - Country:US
Practice Address - Phone:518-346-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016610-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400054905Medicare PIN
NYA400049246Medicare PIN