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NPI Code Detail

MEDICARE: EDWARD ANDREW BONIECKI OT/L

MEDICARE: EDWARD ANDREW BONIECKI OT/L
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 Therapist803MT

General Provider Information

NPI Number : 1639221559
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD ANDREW BONIECKI OT/L
Provider Business Mailing Address
First Line : PO BOX 171
Second Line :
City : FLORENCE
State : MT
Zip : 59833-0171
Country : US
Telephone Number : 406-273-9038
Fax Number :
Provider Business Practice Location Address
First Line : 901 SW HIGGINS AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59803-3600
Country : US
Telephone Number : 406-214-2606
Fax Number : 406-213-0073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 09/08/2021

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