Provider Demographics
NPI:1508024225
Name:BONN, JILL ANDREA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANDREA
Last Name:BONN
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 1:1417 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6533
Mailing Address - Country:US
Mailing Address - Phone:252-338-4044
Mailing Address - Fax:
Practice Address - Street 1:1417 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6533
Practice Address - Country:US
Practice Address - Phone:252-338-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4625225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics