Individual
MR. MARC DOMINIC BAZZANELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4502 MILWAUKEE ST, MADISON, WI 53714-2133
(608) 249-2137
Mailing address
29 PLEASANT OAK CT, OREGON, WI 53575-3225
(831) 278-0465
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5218-26
WI
Other
Enumeration date
06/28/2011
Last updated
07/30/2012
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