Individual
RANDY BUGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4101 SOUTHPOINT DR E, JACKSONVILLE, FL 32216-0996
(904) 296-6800
Mailing address
4101 SOUTHPOINT DR E, JACKSONVILLE, FL 32216-0996
(904) 296-6800
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
15990
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15990
COTA
FL
Enumeration date
06/22/2017
Last updated
06/22/2017
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