Healthcare Provider Details

I. General information

NPI: 1053851683
Provider Name (Legal Business Name): ALICIA SCOTT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 HUDSON LN
MONROE LA
71201-6035
US

IV. Provider business mailing address

1103 HUDSON LN
MONROE LA
71201-6035
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-6500
  • Fax: 318-322-5118
Mailing address:
  • Phone: 318-322-6500
  • Fax: 318-322-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ12505
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: