Provider Demographics
NPI:1477706927
Name:BONDURA, BETHANY LAUREL (MSOTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LAUREL
Last Name:BONDURA
Suffix:
Gender:F
Credentials:MSOTR/L, CLT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:LAUREL
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L, CLT
Mailing Address - Street 1:1870 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-4126
Mailing Address - Country:US
Mailing Address - Phone:484-866-6392
Mailing Address - Fax:
Practice Address - Street 1:305 CHERRY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1803
Practice Address - Country:US
Practice Address - Phone:800-974-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist