Provider Demographics
NPI:1326438565
Name:SCOTT, REVEKEO
Entity Type:Individual
Prefix:
First Name:REVEKEO
Middle Name:
Last Name:SCOTT
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 1:908 FRIARSGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2774
Mailing Address - Country:US
Mailing Address - Phone:803-609-0992
Mailing Address - Fax:803-407-6416
Practice Address - Street 1:908 FRIARSGATE BLVD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2774
Practice Address - Country:US
Practice Address - Phone:803-609-0992
Practice Address - Fax:803-407-6416
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171WH0202XOther Service ProvidersContractorHome Modifications
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant