MEDICARE: DAVID BOKELMAN M.ED.

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	103TS0200X	School Psychologist	SP58	OH

General Provider Information

NPI Number	:	1881094787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BOKELMAN M.ED.

Provider Business Mailing Address
First Line	:	800 COMPTON RD UNIT 18
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3846
Country	:	US
Telephone Number	:	513-729-2111
Fax Number	:	513-729-2109

Provider Business Practice Location Address
First Line	:	800 COMPTON RD UNIT 18
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3846
Country	:	US
Telephone Number	:	513-729-2111
Fax Number	:	513-729-2109

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

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/27/2014

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