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NPI Code Detail

MEDICARE: BONNY KING O.T.

MEDICARE: BONNY KING O.T.
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
1224Z00000XOccupational Therapy AssistantOT001251OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT001251OTHEROHO.T.

General Provider Information

NPI Number : 1598897498
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNY KING O.T.
Provider Business Mailing Address
First Line : 640 WEST MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44303
Country : US
Telephone Number : 330-762-5425
Fax Number :
Provider Business Practice Location Address
First Line : 640 W MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44303-1413
Country : US
Telephone Number : 330-762-5425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 07/23/2008

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