Healthcare Provider Details

I. General information

NPI: 1053780346
Provider Name (Legal Business Name): BONNIE HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9A OLD MINE RD
SANDYSTON NJ
07851-2013
US

IV. Provider business mailing address

9A OLD MINE RD
SANDYSTON NJ
07851-2013
US

V. Phone/Fax

Practice location:
  • Phone: 973-800-0124
  • Fax:
Mailing address:
  • Phone: 973-800-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP008282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: