MEDICARE: COLIN BONFIGLIO

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
1	225X00000X	Occupational Therapist	3649	TN
2	225XN1300X	Neurorehabilitation Occupational Therapist
3	225XR0403X	Driving and Community Mobility Occupational Therapist

General Provider Information

NPI Number	:	1700278462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN BONFIGLIO

Provider Business Mailing Address
First Line	:	1215 21ST AVE S
Second Line	:	SUITE, 9211
City	:	NASHVILLE
State	:	TN
Zip	:	37232-8590
Country	:	US
Telephone Number	:	615-936-5040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 21ST AVE S
Second Line	:	SUITE, 9211
City	:	NASHVILLE
State	:	TN
Zip	:	37232-8590
Country	:	US
Telephone Number	:	615-936-5040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	03/04/2015

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