Provider Demographics
NPI:1124511258
Name:SCOTT, MICHELLE MERSON (OT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MERSON
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 LUXENBAY LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6659
Mailing Address - Country:US
Mailing Address - Phone:757-549-8400
Mailing Address - Fax:
Practice Address - Street 1:2107 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3527
Practice Address - Country:US
Practice Address - Phone:757-494-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002491225X00000X
0119002491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist