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NPI Code Detail

MEDICARE: ANDREA BONZELL

MEDICARE: ANDREA BONZELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5652WI

General Provider Information

NPI Number : 1417315649
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA BONZELL
Provider Business Mailing Address
First Line : 1680 S HURON RD APT 10
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1755 WITTINGTON PL STE 175
Second Line :
City : DALLAS
State : TX
Zip : 75234-1905
Country : US
Telephone Number : 214-442-4470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2016
Last Update Date : 02/02/2016

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Directions to “ ANDREA BONZELL ” Practice Location

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