Provider Demographics
NPI:1295517894
Name:BONDS, DYLAN D
Entity type:Individual
Prefix:MRS
First Name:DYLAN
Middle Name:D
Last Name:BONDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DYLAN
Other - Middle Name:T
Other - Last Name:DEJAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2514 BURNEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 COVENANT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4216
Practice Address - Country:US
Practice Address - Phone:803-787-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.7034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist