Provider Demographics
NPI:1003007949
Name:MROCZKOWSKI, BONNIE L (COTAL)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:MROCZKOWSKI
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8917 E PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-7951
Mailing Address - Country:US
Mailing Address - Phone:520-296-6966
Mailing Address - Fax:
Practice Address - Street 1:2303 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2716
Practice Address - Country:US
Practice Address - Phone:520-360-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1515224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant