Provider Demographics
NPI:1952708463
Name:CLEAVELAND, BONNIE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CLEAVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4566 GOODRICH HWY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97462-9636
Mailing Address - Country:US
Mailing Address - Phone:541-255-6569
Mailing Address - Fax:
Practice Address - Street 1:4566 GOODRICH HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:OR
Practice Address - Zip Code:97462-9636
Practice Address - Country:US
Practice Address - Phone:541-255-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist