Healthcare Provider Details

I. General information

NPI: 1073653226
Provider Name (Legal Business Name): EVELYN JEAN BONANO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W WILLIAMS ST UNIT 346
APEX NC
27502-1998
US

IV. Provider business mailing address

6813 CANDLEWOOD DR
RALEIGH NC
27612-1701
US

V. Phone/Fax

Practice location:
  • Phone: 919-448-6018
  • Fax:
Mailing address:
  • Phone: 919-847-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: