Provider Demographics
NPI:1710449228
Name:HUMMER-WHEELER, BONNIE FAYE (COTA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:FAYE
Last Name:HUMMER-WHEELER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 CHICKENFOOT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-8232
Mailing Address - Country:US
Mailing Address - Phone:910-964-4764
Mailing Address - Fax:
Practice Address - Street 1:4470 CHICKENFOOT RD
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-8232
Practice Address - Country:US
Practice Address - Phone:910-964-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant