Provider Demographics
NPI:1265664239
Name:BONSER, PAULA JEAN (COTA/L)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:BONSER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:JEAN MEYHOFF
Other - Last Name:BONSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:18443 MOORHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-7118
Mailing Address - Country:US
Mailing Address - Phone:352-797-9996
Mailing Address - Fax:
Practice Address - Street 1:725 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2813
Practice Address - Country:US
Practice Address - Phone:352-593-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9260171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor