Provider Demographics
NPI:1346475233
Name:EISENSON, BONNIE F (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:BONNIE
Middle Name:F
Last Name:EISENSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 N 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4008
Mailing Address - Country:US
Mailing Address - Phone:301-537-5955
Mailing Address - Fax:
Practice Address - Street 1:2010 N 49TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-4008
Practice Address - Country:US
Practice Address - Phone:301-537-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9317222Q00000X, 225X00000X, 225X00000X
MD04722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist