MEDICARE: TREVOR BODNAR OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1386163152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR BODNAR OTR/L

Provider Business Mailing Address
First Line	:	815 S VANCE ST APT 303
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4977
Country	:	US
Telephone Number	:	908-528-6544
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 S VANCE ST APT 303
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4977
Country	:	US
Telephone Number	:	908-528-6544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	07/21/2022

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Directions to “ TREVOR BODNAR OTR/L” Practice Location

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