Provider Demographics
NPI:1467176461
Name:THOMAS, BONNIE (OTA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:MOTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1439 WYNONAH DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9211
Mailing Address - Country:US
Mailing Address - Phone:570-573-9794
Mailing Address - Fax:
Practice Address - Street 1:500 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2018
Practice Address - Country:US
Practice Address - Phone:570-874-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008357224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant