MEDICARE: MRS. JUDITH MAE SCOTT O.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	OT 00000555	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT 00000555	OTHER	WA	OCCUPATIONAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1154671998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH MAE SCOTT O.T.

Provider Business Mailing Address
First Line	:	5203 80TH ST E
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98443-2753
Country	:	US
Telephone Number	:	253-537-6266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 E 65TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98404-2238
Country	:	US
Telephone Number	:	253-571-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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