Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 9714 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 9714 | CA |
NPI | 1720442221 |
---|---|
Provider Name | Douglas Scott |
First Address | Long Beach, CA 90806-1344 |
Second Address | Orange, CA 92868-3217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 11/04/2016 |