Provider Demographics
NPI:1518110311
Name:MOYLAN, R. SCOTT (MS, LAC)
Entity Type:Individual
Prefix:MR
First Name:R. SCOTT
Middle Name:
Last Name:MOYLAN
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3620
Mailing Address - Country:US
Mailing Address - Phone:802-288-8160
Mailing Address - Fax:
Practice Address - Street 1:62 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3620
Practice Address - Country:US
Practice Address - Phone:802-288-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000123171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist