Provider Demographics
NPI:1972714061
Name:BONZULAK ANWEILER, DIANA LYNNE (COTA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:BONZULAK ANWEILER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNNE
Other - Last Name:BONZULAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:38 CROSS HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07946-1412
Mailing Address - Country:US
Mailing Address - Phone:908-580-1478
Mailing Address - Fax:
Practice Address - Street 1:600 S LIVINGSTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5415
Practice Address - Country:US
Practice Address - Phone:800-530-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09015100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant