Healthcare Provider Details

I. General information

NPI: 1518510213
Provider Name (Legal Business Name): AMBER NICOLE BOND CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIGHLAND AVE
CIRCLEVILLE OH
43113-1208
US

IV. Provider business mailing address

110 HIGHLAND AVE
CIRCLEVILLE OH
43113-1208
US

V. Phone/Fax

Practice location:
  • Phone: 740-497-4534
  • Fax:
Mailing address:
  • Phone: 740-497-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberCDCA.171044
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: