Healthcare Provider Details

I. General information

NPI: 1578132130
Provider Name (Legal Business Name): RONALD BOMIA JR. OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 HURONVIEW BLVD
ANN ARBOR MI
48103-2949
US

IV. Provider business mailing address

30317 TIMBERIDGE LN APT 104
FARMINGTON HILLS MI
48336-5483
US

V. Phone/Fax

Practice location:
  • Phone: 734-887-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: