Provider Demographics
NPI:1679921324
Name:BONZEY, ALEXIS DELIA
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DELIA
Last Name:BONZEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:DELIA
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 FULLER DR
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-7617
Mailing Address - Country:US
Mailing Address - Phone:207-899-5912
Mailing Address - Fax:
Practice Address - Street 1:14 FULLER DR
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-7617
Practice Address - Country:US
Practice Address - Phone:207-899-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist