Provider Demographics
NPI:1497236731
Name:MOUNGER, BONNY JEAN (COTA)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:JEAN
Last Name:MOUNGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 COUNTY ROAD 919
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-5322
Mailing Address - Country:US
Mailing Address - Phone:817-319-4070
Mailing Address - Fax:
Practice Address - Street 1:920 E FM 1187
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4349
Practice Address - Country:US
Practice Address - Phone:817-297-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208542224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant