Provider Demographics
NPI:1740758598
Name:GARRETT, SCOTT BOWMAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BOWMAN
Last Name:GARRETT
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 1:831 WILLOW GRANDE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8352
Mailing Address - Country:US
Mailing Address - Phone:601-951-7738
Mailing Address - Fax:
Practice Address - Street 1:501 E NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3604
Practice Address - Country:US
Practice Address - Phone:601-926-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist