Provider Demographics
NPI:1760570444
Name:REA, SCOTT THOMAS (OTR)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:REA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MONTEBELLO SQUARE DR STE C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6901
Mailing Address - Country:US
Mailing Address - Phone:719-599-5330
Mailing Address - Fax:
Practice Address - Street 1:2360 MONTEBELLO SQUARE DR STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6901
Practice Address - Country:US
Practice Address - Phone:719-599-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1054234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45673250Medicaid
CO802110Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER