Provider Demographics
NPI:1770691131
Name:BREIT, BONNIE RUSS (OTR)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:RUSS
Last Name:BREIT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6802
Mailing Address - Country:US
Mailing Address - Phone:610-892-9789
Mailing Address - Fax:
Practice Address - Street 1:203 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6802
Practice Address - Country:US
Practice Address - Phone:610-892-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000651L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist