Healthcare Provider Details

I. General information

NPI: 1275463416
Provider Name (Legal Business Name): CONSTANCE BONIS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 N UNIVERSITY DR STE 101S
TAMARAC FL
33321-6106
US

IV. Provider business mailing address

955 MAEMIR WAY
ROCKLEDGE FL
32955-4601
US

V. Phone/Fax

Practice location:
  • Phone: 866-718-5757
  • Fax: 866-718-5759
Mailing address:
  • Phone: 866-718-5757
  • Fax: 866-718-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: