Provider Demographics
NPI:1265496418
Name:MCDERMOTT, JOHN SCOTT
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOSPITAL DR
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-8516
Mailing Address - Country:US
Mailing Address - Phone:828-894-3718
Mailing Address - Fax:828-894-3806
Practice Address - Street 1:48 HOSPITAL DR
Practice Address - Street 2:SUITE 2-A
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-8516
Practice Address - Country:US
Practice Address - Phone:828-894-3718
Practice Address - Fax:828-894-3806
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5308225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2511153Medicare ID - Type Unspecified