Healthcare Provider Details

I. General information

NPI: 1336572213
Provider Name (Legal Business Name): SCOTT DEAN BERGLUND OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ADAMS ST
AFTON WY
83110-9621
US

IV. Provider business mailing address

4312 BITTER CREEK RD
AFTON WY
83110-9777
US

V. Phone/Fax

Practice location:
  • Phone: 307-885-5800
  • Fax:
Mailing address:
  • Phone: 307-886-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: