Provider Demographics
NPI:1205175940
Name:SCOTT, KELLI RUTH (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RUTH
Last Name:SCOTT
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Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1319 SUNSET DR
Mailing Address - Street 2:SUITE102
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3799
Mailing Address - Country:US
Mailing Address - Phone:423-534-8897
Mailing Address - Fax:423-328-8662
Practice Address - Street 1:1319 SUNSET DR
Practice Address - Street 2:SUITE102
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3799
Practice Address - Country:US
Practice Address - Phone:423-534-8897
Practice Address - Fax:423-328-8662
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3271225XP0200X
VA0119003962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist