Provider Demographics
NPI:1265585194
Name:PYATT, BONNIE LEE (MOT, OTRL)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEE
Last Name:PYATT
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 N SHERIDAN RD APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2088
Mailing Address - Country:US
Mailing Address - Phone:708-334-3145
Mailing Address - Fax:
Practice Address - Street 1:307 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4140
Practice Address - Country:US
Practice Address - Phone:312-238-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist