Provider Demographics
NPI:1043105257
Name:BONHAM, BLAKELEE BUTLER (MS OTR/L)
Entity type:Individual
Prefix:
First Name:BLAKELEE
Middle Name:BUTLER
Last Name:BONHAM
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NOYANT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5078
Mailing Address - Country:US
Mailing Address - Phone:870-578-8561
Mailing Address - Fax:
Practice Address - Street 1:131 NOYANT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5078
Practice Address - Country:US
Practice Address - Phone:870-578-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist