Provider Demographics
NPI:1255496261
Name:TODD, BONNIE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1668
Mailing Address - Street 2:815 TRIPLETT ST
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302
Mailing Address - Country:US
Mailing Address - Phone:270-683-4517
Mailing Address - Fax:270-852-1490
Practice Address - Street 1:815 TRIPLETT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42302
Practice Address - Country:US
Practice Address - Phone:270-683-4517
Practice Address - Fax:270-852-1490
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKYR1517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11903135Medicaid
KY45118379Medicaid
KY33000035Medicaid
KY11903135Medicaid