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Individual

JULIE TESSLER BONAMO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L, CHT

Contact information

Practice address
3635 S CLYDE MORRIS BLVD, ST. 300, PORT ORANGE, FL 32129-2300
(386) 258-8080
(386) 258-8177
Mailing address
3635 S CLYDE MORRIS BLVD, ST. 300, PORT ORANGE, FL 32129-2300
(386) 258-8080
(386) 258-8177

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT5228
FL
225XH1200X
Hand Occupational Therapist
OT5228
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
892520800
FL
01
Z7064
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
07/29/2006
Last updated
07/07/2010
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