Provider Demographics
NPI:1699248872
Name:WASSMER, SCOTT DALE (COTA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DALE
Last Name:WASSMER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833A PAAHANA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2139
Mailing Address - Country:US
Mailing Address - Phone:808-372-3482
Mailing Address - Fax:
Practice Address - Street 1:2459 10TH AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3051
Practice Address - Country:US
Practice Address - Phone:808-564-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOTA-183224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant