Provider Demographics
NPI:1932325453
Name:CHILTON, BONNIE S (OTR)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:S
Last Name:CHILTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:S
Other - Last Name:GRIEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:834 N SOCORA ST
Practice Address - Street 2:STE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3279
Practice Address - Country:US
Practice Address - Phone:316-440-3731
Practice Address - Fax:316-440-3741
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist