Provider Demographics
NPI:1104521335
Name:SCOTT, DEREK BRIAN (LMT, NMT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:BRIAN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W GAMBIER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3301
Mailing Address - Country:US
Mailing Address - Phone:740-398-7187
Mailing Address - Fax:
Practice Address - Street 1:9 W GAMBIER ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3301
Practice Address - Country:US
Practice Address - Phone:740-398-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH018729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist