Provider Demographics
NPI:1760079628
Name:BUGLIONE, KARL ANTHONY (OTRL)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:ANTHONY
Last Name:BUGLIONE
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:MR
Other - First Name:KARL
Other - Middle Name:ANTHONY
Other - Last Name:BUGLIONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTRL
Mailing Address - Street 1:7200 CHALLIS RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7411
Mailing Address - Country:US
Mailing Address - Phone:810-227-0119
Mailing Address - Fax:
Practice Address - Street 1:7200 CHALLIS RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-7411
Practice Address - Country:US
Practice Address - Phone:810-227-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006779225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty