Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 3649 | TN |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 225XR0403X | Driving and Community Mobility |
NPI | 1700278462 |
---|---|
Provider Name | Colin Bonfiglio |
First Address | Nashville, TN 37232-8590 |
Second Address | Nashville, TN 37232-8590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 04/03/2015 |