Provider Demographics
NPI:1184605289
Name:PHELPS, SCOTT R (OT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:PHELPS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3218
Mailing Address - Country:US
Mailing Address - Phone:330-297-9020
Mailing Address - Fax:330-297-9095
Practice Address - Street 1:35 N CLEVELAND AVE
Practice Address - Street 2:ALLIED HEALTH REHAB CENTER
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1365
Practice Address - Country:US
Practice Address - Phone:330-628-0736
Practice Address - Fax:330-628-0739
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 00748225X00000X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT 00748OtherOHIO BOARD OF PT OT ATC
OHOT 00748OtherOHIO BOARD OF PT OT ATC