Provider Demographics
NPI:1326006172
Name:BONYNGE, REGINA CAROL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:CAROL
Last Name:BONYNGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5523 MAGNOLIA BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3275
Mailing Address - Country:US
Mailing Address - Phone:941-926-8778
Mailing Address - Fax:941-926-8778
Practice Address - Street 1:5523 MAGNOLIA BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3275
Practice Address - Country:US
Practice Address - Phone:941-926-8778
Practice Address - Fax:941-926-8778
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT2091OtherOT LICENSE
FLP00458291OtherRAILROAD MEDICARE
FLZ5555OtherBLUE CROSS & BLUE SHIELD
FLOT2091OtherOT LICENSE