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General NPI Number Information
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NPI Number | 1639221559
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Entity Type | Individual
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Provider Name | EDWARD ANDREW BONIECKI OT/L
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 901 SW HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59803-3600
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Country | US
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Telephone | 406-214-2606
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Fax | 406-213-0073
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Provider Business Mailing Address
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Address Line | PO BOX 171
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City | FLORENCE
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State | MT
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Zip | 59833-0171
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Country | US
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Telephone | 406-273-9038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 803
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License Number State | MT
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