Provider Demographics
NPI:1740380765
Name:BERUBE, SCOTT A (OT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:BERUBE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4029
Mailing Address - Country:US
Mailing Address - Phone:410-535-8180
Mailing Address - Fax:410-535-8325
Practice Address - Street 1:130 HOSPITAL RD STE 103
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4029
Practice Address - Country:US
Practice Address - Phone:410-535-8180
Practice Address - Fax:410-535-8325
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03924174400000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606MMedicare ID - Type UnspecifiedMEDICARE