Provider Demographics
NPI:1023639838
Name:SCOTT, KENNETH GOLDIE (OTR)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GOLDIE
Last Name:SCOTT
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 1:17226 PINE HOLLOW LANDING CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7801
Mailing Address - Country:US
Mailing Address - Phone:281-222-4595
Mailing Address - Fax:
Practice Address - Street 1:2907 BROADWAY BEND DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2236
Practice Address - Country:US
Practice Address - Phone:832-699-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111066225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist