Provider Demographics
NPI:1780829812
Name:BONNIE J WATKINS OTR INC
Entity Type:Organization
Organization Name:BONNIE J WATKINS OTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:817-929-5792
Mailing Address - Street 1:128 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6651
Mailing Address - Country:US
Mailing Address - Phone:817-929-5792
Mailing Address - Fax:
Practice Address - Street 1:128 STONEGATE CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6651
Practice Address - Country:US
Practice Address - Phone:817-929-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101183302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization