Provider Demographics
NPI:1881989127
Name:FLEET, BONNIE LEE (OTR)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEE
Last Name:FLEET
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 1:383 SUNSET RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:VA
Mailing Address - Zip Code:24538-3592
Mailing Address - Country:US
Mailing Address - Phone:434-221-9929
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST CIR
Practice Address - Street 2:SUITE 108
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-5551
Practice Address - Country:US
Practice Address - Phone:800-969-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist