MEDICARE: MS. BONNIE L LOCKE C.O.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	210140	TX

General Provider Information

NPI Number	:	1174795702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONNIE L LOCKE C.O.T.A.

Provider Business Mailing Address
First Line	:	48315 WALDEN
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044
Country	:	US
Telephone Number	:	586-909-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 MAPLE AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-1337
Country	:	US
Telephone Number	:	866-724-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	03/24/2008

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Directions to “ MS. BONNIE L LOCKE C.O.T.A.” Practice Location

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