Provider Demographics
NPI:1285330225
Name:MAKI, SCOTT DOUGLAS (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:MAKI
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8365 N NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1149
Mailing Address - Country:US
Mailing Address - Phone:734-416-2000
Mailing Address - Fax:
Practice Address - Street 1:8365 N NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1149
Practice Address - Country:US
Practice Address - Phone:734-416-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201013194OtherOT STATE LICENSURE