Provider Demographics
NPI:1356628903
Name:BODENSTEDT, BONNIE LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:BODENSTEDT
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 1:402 S JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3108
Mailing Address - Country:US
Mailing Address - Phone:936-632-2107
Mailing Address - Fax:936-632-2108
Practice Address - Street 1:402 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3108
Practice Address - Country:US
Practice Address - Phone:936-632-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008942-1225X00000X
TX114951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist