Provider Demographics
NPI:1992121974
Name:ROOD, SCOTT PATRICK (OTR/L)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:PATRICK
Last Name:ROOD
Suffix:
Gender:M
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 1:421 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-1017
Mailing Address - Country:US
Mailing Address - Phone:616-648-9055
Mailing Address - Fax:
Practice Address - Street 1:421 WATSON ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1017
Practice Address - Country:US
Practice Address - Phone:616-648-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist