MEDICARE: JESSICA LAUREN SCOTT OTR

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	225XP0200X	Pediatric Occupational Therapist	OT009706	OH
2	225X00000X	Occupational Therapist	OT009706	OH

General Provider Information

NPI Number	:	1295251387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAUREN SCOTT OTR

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	29077 CLEMENS RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1135
Country	:	US
Telephone Number	:	440-871-6568
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	06/19/2023

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