Provider Demographics
NPI:1972826329
Name:OWENS, BONITA A (OTR/L)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:A
Last Name:OWENS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 VALLEY CREST LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2889
Mailing Address - Country:US
Mailing Address - Phone:931-368-0052
Mailing Address - Fax:
Practice Address - Street 1:159 VALLEY CREST LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2889
Practice Address - Country:US
Practice Address - Phone:931-368-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1917171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor