Healthcare Provider Details

I. General information

NPI: 1720442221
Provider Name (Legal Business Name): DOUGLAS SCOTT MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MANCHESTER AVE SUITE120
ORANGE CA
92868-3217
US

IV. Provider business mailing address

3023 DAISY AVE
LONG BEACH CA
90806-1344
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5568
  • Fax:
Mailing address:
  • Phone: 714-328-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number9714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number9714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: