Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT 00748 | OH |
N | 225XH1200X | Occupational Therapist - Hand | OT 00748 | OH |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 00748 | OH |
NPI | 1184605289 |
---|---|
Provider Name | Scott R Phelps |
First Address | Ravenna, OH 44266-3218 |
Second Address | Mogadore, OH 44260-1365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT 00748 | OHIO BOARD OF PT OT ATC (01) | OH |