Provider Demographics
NPI:1336572213
Name:BERGLUND, SCOTT DEAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DEAN
Last Name:BERGLUND
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 BITTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-9777
Mailing Address - Country:US
Mailing Address - Phone:307-886-5208
Mailing Address - Fax:
Practice Address - Street 1:901 ADAMS ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-9621
Practice Address - Country:US
Practice Address - Phone:307-885-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No273Y00000XHospital UnitsRehabilitation Unit