Provider Demographics
NPI:1336683358
Name:TAPIO, JON RICHARD (BOC ORTHOTIST)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:RICHARD
Last Name:TAPIO
Suffix:
Gender:M
Credentials:BOC ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MI
Mailing Address - Zip Code:49879
Mailing Address - Country:US
Mailing Address - Phone:906-376-8000
Mailing Address - Fax:616-884-8119
Practice Address - Street 1:431 FRONT STREET
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MI
Practice Address - Zip Code:49879
Practice Address - Country:US
Practice Address - Phone:906-376-8000
Practice Address - Fax:616-884-8119
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEIN81-4646362246Y00000X
222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information