Healthcare Provider Details

I. General information

NPI: 1386902716
Provider Name (Legal Business Name): KAREN ANN SCOTT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 E. MOORES PIKE LEGACY HEALTH CARE AT REDBUD HILLS
BLOOMINGTON IN
47401
US

IV. Provider business mailing address

3211 E. MOORES PIKE LEGACY HEALTH CARE AT RED BUD HILLS
BLOOMINGTON IN
47401
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-7604
  • Fax: 812-334-7705
Mailing address:
  • Phone: 812-334-7604
  • Fax: 812-334-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31000714A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: