Provider Demographics
NPI:1669696381
Name:SCOTT, AMANDA L (OTRL)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10334 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7667
Mailing Address - Country:US
Mailing Address - Phone:484-319-6999
Mailing Address - Fax:
Practice Address - Street 1:1700 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4520
Practice Address - Country:US
Practice Address - Phone:219-464-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009429225X00000X
IN31003327A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist