Provider Demographics
NPI:1073986105
Name:NIEMANN, BONNIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:NIEMANN
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 1:1801 E UPRIVER DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5181
Mailing Address - Country:US
Mailing Address - Phone:509-482-8191
Mailing Address - Fax:509-482-8386
Practice Address - Street 1:1801 E UPRIVER DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5181
Practice Address - Country:US
Practice Address - Phone:509-482-8191
Practice Address - Fax:509-482-8386
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 00000190310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility