Provider Demographics
NPI:1346237526
Name:BONHOMME, LORETTE BERNADETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORETTE
Middle Name:BERNADETTE
Last Name:BONHOMME
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LORETTE
Other - Middle Name:BERNADETTE
Other - Last Name:AFRICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4218 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-4894
Mailing Address - Country:US
Mailing Address - Phone:863-382-2930
Mailing Address - Fax:863-471-1251
Practice Address - Street 1:123 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2100
Practice Address - Country:US
Practice Address - Phone:863-471-6303
Practice Address - Fax:863-471-1251
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9071OtherBLUE CROSS/BLUE SHIELD
FLZ9071OtherBLUE CROSS/BLUE SHIELD