Provider Demographics
NPI:1568859684
Name:GIVEN, BONNIE LYN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LYN
Last Name:GIVEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYN
Other - Last Name:DILLINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7673 S SUMMIT PEAK DR D208
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84046
Mailing Address - Country:US
Mailing Address - Phone:801-989-8679
Mailing Address - Fax:
Practice Address - Street 1:2500 S STATE ST
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3164
Practice Address - Country:US
Practice Address - Phone:801-989-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9363203-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist