Healthcare Provider Details

I. General information

NPI: 1720753429
Provider Name (Legal Business Name): SCOTT WILLIAM RUOTOLO OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAKE ST
NEW BRITAIN CT
06052-1396
US

IV. Provider business mailing address

100 JACK ENGLISH DR
MIDDLETOWN CT
06457-4079
US

V. Phone/Fax

Practice location:
  • Phone: 860-832-4666
  • Fax: 860-348-4931
Mailing address:
  • Phone: 203-927-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003993
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: