Provider Demographics
NPI:1205099199
Name:ANDERSON, SCOTT MONROE (OTR/L)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MONROE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:MONROE
Other - Last Name:SWESEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 STOKES ST
Mailing Address - Street 2:APT. 91
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4753
Mailing Address - Country:US
Mailing Address - Phone:707-330-1539
Mailing Address - Fax:
Practice Address - Street 1:991 CLYDE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1905
Practice Address - Country:US
Practice Address - Phone:707-330-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003411225X00000X
CA11164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist