Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1509 | ND |
NPI | 1306368220 |
---|---|
Provider Name | Scott Vandyke |
First Address | Bismarck, ND 58501-4439 |
Second Address | Bismarck, ND 58501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 12/07/2017 |