Provider Demographics
NPI:1316379753
Name:BONNER, REBECCA LYNN (MS, OTR/L CHT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS, OTR/L CHT
Other - Prefix:
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Mailing Address - Street 1:555 COUNTY ROAD HQ
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8855
Mailing Address - Country:US
Mailing Address - Phone:906-225-5044
Mailing Address - Fax:906-225-5049
Practice Address - Street 1:710 S LINCOLN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1292
Practice Address - Country:US
Practice Address - Phone:906-789-2639
Practice Address - Fax:906-789-3764
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5201006936225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand