Provider Demographics
NPI:1558610634
Name:VIGSTOL, SCOTT MICHAEL (OT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:VIGSTOL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12565 WEST CENTER ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3810
Mailing Address - Country:US
Mailing Address - Phone:402-342-5566
Mailing Address - Fax:402-342-0034
Practice Address - Street 1:12565 WEST CENTER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3810
Practice Address - Country:US
Practice Address - Phone:402-342-5566
Practice Address - Fax:402-342-0034
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist