Individual
NICOLAS BRAVO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 HOSPITAL RD, FORT GORDON, GA 30905-5950
(706) 787-1049
Mailing address
300 HOSPITAL RD, FORT GORDON, GA 30905-5950
(706) 787-1049
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
05701
MD
225X00000X
Occupational Therapist
Primary
OC014474
PA
Other
Enumeration date
08/17/2006
Last updated
05/22/2023
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