Provider Demographics
NPI:1093326068
Name:DILLON, BONNIE ALLYSON (COTA/L)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ALLYSON
Last Name:DILLON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:ALLYSON
Other - Last Name:GRADDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-1949
Mailing Address - Country:US
Mailing Address - Phone:870-586-8601
Mailing Address - Fax:
Practice Address - Street 1:419 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2754
Practice Address - Country:US
Practice Address - Phone:870-857-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A976224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant