Jeff Richard Bazanele, OT
Individual provider Active NPI Occupational Therapist · Camp Lejeune, NC
NPI 1275912701 · NPPES record last updated Oct 29, 2023
Key facts
- NPI
- 1275912701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 6969 (CO)
- Practice address
- 100 Brewster Blvd
Camp Lejeune, NC 28547-2575 - Phone
- (505) 944-7224
- Fax
- (505) 944-7229
- NPI assigned
- May 29, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6969 | CO | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peanut Butter and Jelly Family Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 6969 | CO | Yes |
Addresses
Primary practice location
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Mailing address
1101 Lopez Road SW
Albuquerque, NM 87105
Phone (505) 877-7060
Other providers in Camp Lejeune, NC
- Cynthia Bartlett
- Lauren Marie Barton
- Angela M Bartow
- Joshua Thomas Bautz
- Ronnie David Bayless Jr.
- Bda Camp Lejeune
- BDC Camp Geiger
- BDC Courthouse Bay
- BDC Johnson
- BDC McAs Cherry Point
All providers in Camp Lejeune, NC · Occupational Therapist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.