Healthcare Provider Details

I. General information

NPI: 1306956941
Provider Name (Legal Business Name): PAUL BONZANI OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75A LIVINGSTON ST
ASHEVILLE NC
28801-4353
US

IV. Provider business mailing address

75 MOULTON RIDGE RD
KENSINGTON NH
03833-5508
US

V. Phone/Fax

Practice location:
  • Phone: 828-281-7171
  • Fax:
Mailing address:
  • Phone: 561-504-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11395
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2065
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2231
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: