=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194207209
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN HANCOCK BONGIOVANNI OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2018
-----------------------------------------------------
Last Update Date | 09/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 VILLAGE PL
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-6171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-682-0230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2410 JENNIFER HOPE BLVD
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-4726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-443-5389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Occupational Therapist
-----------------------------------------------------
License Number | OT-7918
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------