Provider Demographics
NPI:1710079660
Name:FAMOLARI, BONNIE JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:FAMOLARI
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 1:1707 CRESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6730
Mailing Address - Country:US
Mailing Address - Phone:704-843-7751
Mailing Address - Fax:
Practice Address - Street 1:1707 CRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6730
Practice Address - Country:US
Practice Address - Phone:704-843-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist