Individual
SCOTT J DESORMEAUX
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
121 TIVOLI ST, ABBEVILLE, LA 70510-5150
(337) 652-9530
Mailing address
121 TIVOLI ST, ABBEVILLE, LA 70510-5150
(337) 652-9530
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z11169
STATE LICENSE
LA
Enumeration date
06/03/2006
Last updated
07/08/2007
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