Provider Demographics
NPI:1447899612
Name:SCOTT, KRYSTAL (OTR)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:JREIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 COUNTY ROAD 1109
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:TX
Mailing Address - Zip Code:75567-3414
Mailing Address - Country:US
Mailing Address - Phone:903-293-9917
Mailing Address - Fax:
Practice Address - Street 1:407 CARSON ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6852
Practice Address - Country:US
Practice Address - Phone:501-624-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist