Individual
DUSTIN J CARBONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1527 WEST TILL ROAD, FORT WAYNE, IN 46825
(260) 312-1794
Mailing address
1527 W TILL RD, FORT WAYNE, IN 46825-2151
(260) 312-1794
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001836A
IN
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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