Provider Demographics
NPI:1962814251
Name:SCOTT, ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 BRENTFORD PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5622
Mailing Address - Country:US
Mailing Address - Phone:404-542-7384
Mailing Address - Fax:
Practice Address - Street 1:2531 BRENTFORD PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5622
Practice Address - Country:US
Practice Address - Phone:404-542-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001686224Z00000X
TX212390224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant