Healthcare Provider Details

I. General information

NPI: 1750869046
Provider Name (Legal Business Name): DAVID BRUNO CICHON MS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W MIDDLE ST
CHELSEA MI
48118
US

IV. Provider business mailing address

5435 BUNKER RD
MASON MI
48854-9768
US

V. Phone/Fax

Practice location:
  • Phone: 734-433-1000
  • Fax:
Mailing address:
  • Phone: 517-930-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: