Healthcare Provider Details

I. General information

NPI: 1356943344
Provider Name (Legal Business Name): SCOTT ROBERT PRESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7745 ROCK PORT WAY
WEST CHESTER OH
45069-9423
US

IV. Provider business mailing address

7708 DEARBORN AVE
CINCINNATI OH
45236-3034
US

V. Phone/Fax

Practice location:
  • Phone: 513-685-5555
  • Fax:
Mailing address:
  • Phone: 513-685-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: