Provider Demographics
NPI:1225258684
Name:CLANCY, BONNIE JEAN (OTR)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN
Last Name:CLANCY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 BEACH RD
Mailing Address - Street 2:UNIT 105
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-6930
Mailing Address - Country:US
Mailing Address - Phone:239-395-9060
Mailing Address - Fax:
Practice Address - Street 1:1039 BEACH RD
Practice Address - Street 2:UNIT 105
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-6930
Practice Address - Country:US
Practice Address - Phone:239-395-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8163Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY