MEDICARE: SCOTT R PHELPS OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT 00748	OH
2	225XH1200X	Hand Occupational Therapist	OT 00748	OH
3	225XN1300X	Neurorehabilitation Occupational Therapist	OT 00748	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT 00748	OTHER	OH	OHIO BOARD OF PT OT ATC

General Provider Information

NPI Number	:	1184605289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT R PHELPS OT

Provider Business Mailing Address
First Line	:	533 E MAIN ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3218
Country	:	US
Telephone Number	:	330-297-9020
Fax Number	:	330-297-9095

Provider Business Practice Location Address
First Line	:	35 N CLEVELAND AVE
Second Line	:	ALLIED HEALTH REHAB CENTER
City	:	MOGADORE
State	:	OH
Zip	:	44260-1365
Country	:	US
Telephone Number	:	330-628-0736
Fax Number	:	330-628-0739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/11/2025

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