Provider Demographics
NPI:1487010062
Name:VERMEULEN, SCOTT (CO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:VERMEULEN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 ANDERSON RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3505
Mailing Address - Country:US
Mailing Address - Phone:530-204-5123
Mailing Address - Fax:
Practice Address - Street 1:635 ANDERSON RD
Practice Address - Street 2:SUITE 18
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3505
Practice Address - Country:US
Practice Address - Phone:530-204-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist