Provider Demographics
NPI:1760683981
Name:BONTA, MAUREEN KING (OTR)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:KING
Last Name:BONTA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1696
Mailing Address - Street 2:
Mailing Address - City:OGUNQUIT
Mailing Address - State:ME
Mailing Address - Zip Code:03907-1696
Mailing Address - Country:US
Mailing Address - Phone:207-676-4401
Mailing Address - Fax:
Practice Address - Street 1:57 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1203
Practice Address - Country:US
Practice Address - Phone:207-384-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist