Provider Demographics
NPI:1245504547
Name:SCOTT-WEBER, MICHELLE JOANN (OTD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JOANN
Last Name:SCOTT-WEBER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BOGARD RD
Mailing Address - Street 2:BUILDING A SUITE 1
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6563
Mailing Address - Country:US
Mailing Address - Phone:907-232-7976
Mailing Address - Fax:907-357-7727
Practice Address - Street 1:1700 E BOGARD RD
Practice Address - Street 2:BUILDING A SUITE 1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6563
Practice Address - Country:US
Practice Address - Phone:907-232-7976
Practice Address - Fax:907-357-7727
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist