Provider Demographics
NPI:1154857639
Name:BRUNO, KELLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 LLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-7115
Mailing Address - Country:US
Mailing Address - Phone:330-322-4010
Mailing Address - Fax:
Practice Address - Street 1:1181 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-7115
Practice Address - Country:US
Practice Address - Phone:330-322-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA0063252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer