Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201006779 | MI |
NPI | 1760079628 |
---|---|
Provider Name | Mr. Karl Anthony Buglione |
First Address | Brighton, MI 48116-7411 |
Second Address | Brighton, MI 48116-7411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2020 |
Last Update Date | 28/12/2020 |