Healthcare Provider Details

I. General information

NPI: 1215413422
Provider Name (Legal Business Name): BONNIE DUNDEE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MISSION ST
SAN FRANCISCO CA
94110-5419
US

IV. Provider business mailing address

432 SANCHEZ ST
SAN FRANCISCO CA
94114-2018
US

V. Phone/Fax

Practice location:
  • Phone: 415-695-1400
  • Fax:
Mailing address:
  • Phone: 415-730-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: