Provider Demographics
NPI:1750869046
Name:CICHON, DAVID BRUNO (MS OTR/L)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUNO
Last Name:CICHON
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 BUNKER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9768
Mailing Address - Country:US
Mailing Address - Phone:517-930-6088
Mailing Address - Fax:
Practice Address - Street 1:805 W MIDDLE ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-433-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MI5201009525225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist