MEDICARE: SUZANNE SCOTT

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	225XP0200X	Pediatric Occupational Therapist	OT.007015	OH

General Provider Information

NPI Number	:	1346607736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE SCOTT

Provider Business Mailing Address
First Line	:	1222 GLADYS AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2510
Country	:	US
Telephone Number	:	216-577-9058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 GLADYS AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2510
Country	:	US
Telephone Number	:	216-577-9058
Fax Number	:

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

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	01/15/2016

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Directions to “ SUZANNE SCOTT ” Practice Location

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