Provider Demographics
NPI:1740417161
Name:SCOTT, BRADLEY DARIAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DARIAN
Last Name:SCOTT
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 1:3463 MAGIC DR STE 255
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2998
Mailing Address - Country:US
Mailing Address - Phone:210-582-5840
Mailing Address - Fax:210-582-5841
Practice Address - Street 1:3463 MAGIC DR STE 255
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2998
Practice Address - Country:US
Practice Address - Phone:210-582-5840
Practice Address - Fax:210-582-5841
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist