Provider Demographics
NPI:1831215979
Name:BODNAR, CAROL (OTRL)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:BODNAR
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOBART RD
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5213
Mailing Address - Country:US
Mailing Address - Phone:978-683-6771
Mailing Address - Fax:
Practice Address - Street 1:1 HOBART RD
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5213
Practice Address - Country:US
Practice Address - Phone:978-683-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOG0031OtherBCBSMA GROUP NUMBER
MAOT0107OtherBCBSMA PROVIDER NUMBER
MAOT0107OtherBCBSMA PROVIDER NUMBER