Provider Demographics
NPI:1205226552
Name:TYRRELL, BONNILEE ANNE (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MS
First Name:BONNILEE
Middle Name:ANNE
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:TYRRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1710 NORTH 70TH STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1505
Mailing Address - Country:US
Mailing Address - Phone:402-761-3230
Mailing Address - Fax:
Practice Address - Street 1:7208 VAN DORN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3651
Practice Address - Country:US
Practice Address - Phone:402-499-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE809314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility