Provider Demographics
NPI:1497943419
Name:BOBZIEN, MICHAEL J (OT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BOBZIEN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32320-2041
Mailing Address - Country:US
Mailing Address - Phone:850-653-4545
Mailing Address - Fax:850-653-4949
Practice Address - Street 1:111 AVENUE E
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2041
Practice Address - Country:US
Practice Address - Phone:850-653-4545
Practice Address - Fax:850-653-4949
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL5767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7646Medicare PIN