Individual
MR. KIMMICHAEL BOLOGNINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2793 KINGSMILL AVE, MELBOURNE, FL 32934-7582
(321) 626-3699
Mailing address
2793 KINGSMILL AVE, MELBOURNE, FL 32934-7582
(321) 626-3699
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
16941
FL
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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