Provider Demographics
NPI:1154658110
Name:KENNEDY, BONNIE LYNN (OTR/L, PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR/L, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2302
Mailing Address - Country:US
Mailing Address - Phone:626-799-2795
Mailing Address - Fax:
Practice Address - Street 1:822 ARROYO DR
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2302
Practice Address - Country:US
Practice Address - Phone:626-799-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 10863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist