MEDICARE: MR. SCOTT WAYNE KNUTH OTR

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	1307-026	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710106612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT WAYNE KNUTH OTR

Provider Business Mailing Address
First Line	:	6454 N 51ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-6008
Country	:	US
Telephone Number	:	414-358-1119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 W BENDER RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3801
Country	:	US
Telephone Number	:	414-228-9440
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/09/2007

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