Provider Demographics
NPI:1093041709
Name:CARLSON, BONNIE OLDHAM (OTR/L)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:OLDHAM
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19250 SW 65TH AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7452
Mailing Address - Country:US
Mailing Address - Phone:503-692-1670
Mailing Address - Fax:503-692-1669
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1670
Practice Address - Fax:503-692-1669
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR424176225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics