Provider Demographics
NPI:1669641353
Name:BONCHER, TINA LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:BONCHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LYNN
Other - Last Name:CARUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:42955 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3377
Practice Address - Country:US
Practice Address - Phone:734-981-2100
Practice Address - Fax:734-981-2622
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist