Provider Demographics
NPI:1013552082
Name:SCHLESSELMAN, BONNIE BOWMAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:BOWMAN
Last Name:SCHLESSELMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 BIG HORN AVE SHERIDAN MANOR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-674-4416
Mailing Address - Fax:307-674-5814
Practice Address - Street 1:1851 BIG HORN AVE SHERIDAN MANOR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-673-2109
Practice Address - Fax:307-674-5814
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTA1254224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant