Individual
REVEKEO SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
908 FRIARSGATE BLVD, IRMO, SC 29063-2774
(803) 609-0992
(803) 407-6416
Mailing address
908 FRIARSGATE BLVD, IRMO, SC 29063-2774
(803) 609-0992
(803) 407-6416
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
171WH0202X
Home Modifications Contractor
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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