Mikayla Bonzo, IECE
Individual provider Active NPI Developmental Therapist · Wurtland, KY
NPI 1922714005 · NPPES record last updated May 22, 2023
Key facts
- NPI
- 1922714005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- Practice address
- 58 Van Buren Ave
Wurtland, KY 41144-6238 - Phone
- (606) 694-2362
- NPI assigned
- Jan 23, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Yes |
Addresses
Primary practice location
58 Van Buren Ave
Wurtland, KY 41144-6238
Mailing address
58 Van Buren Ave
Wurtland, KY 41144-6238
Phone (606) 694-2362
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | m1148651@moreheadstate.edu | Direct | Morehead State University |
Other providers in Wurtland, KY
- Curtis Lee Bradley
- Patrick A Click
- Freedom Psychiatry, PLLC
- Greenup County Health Department
- Greenup County Health Department
All providers in Wurtland, KY · Developmental Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 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.