Provider Demographics
NPI:1760446157
Name:BONNIWELL, ELIZABETH JANELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANELLE
Last Name:BONNIWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JANELLE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3915 GOLDEN VALLEY RD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4249
Mailing Address - Country:US
Mailing Address - Phone:763-520-0498
Mailing Address - Fax:763-520-0355
Practice Address - Street 1:3915 GOLDEN VALLEY RD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4249
Practice Address - Country:US
Practice Address - Phone:763-520-0498
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist