Provider Demographics
NPI:1053440230
Name:SMITH, BONNIE ELIZABETH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9826 OSPREY LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5994
Mailing Address - Country:US
Mailing Address - Phone:407-895-4400
Mailing Address - Fax:407-264-8671
Practice Address - Street 1:215 E NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6403
Practice Address - Country:US
Practice Address - Phone:407-895-4400
Practice Address - Fax:407-264-8671
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ139ROtherBLUE SHIELD OF FLORIDA
FLP00423958Medicare PIN
FLAB692YMedicare PIN
FLAB692ZMedicare PIN