Healthcare Provider Details

I. General information

NPI: 1487110862
Provider Name (Legal Business Name): KIMBERLY SCANLON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAKWOOD BLVD STE 130
HOLLYWOOD FL
33020-1937
US

IV. Provider business mailing address

2301 SW 85TH WAY
DAVIE FL
33324-5360
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3844
  • Fax:
Mailing address:
  • Phone: 501-388-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number19787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: