Provider Demographics
NPI:1962087965
Name:SCOTT, JESSICA R (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-741-0056
Mailing Address - Fax:425-741-0057
Practice Address - Street 1:19031 33RD AVE W STE 102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4724
Practice Address - Country:US
Practice Address - Phone:425-741-0056
Practice Address - Fax:425-741-0057
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61136148225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2178283Medicaid