Healthcare Provider Details

I. General information

NPI: 1477706927
Provider Name (Legal Business Name): BETHANY LAUREL BONDURA MSOTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY LAUREL MCCULLOUGH MSOTR/L, CLT

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CHERRY ST
PHILADELPHIA PA
19106-1803
US

IV. Provider business mailing address

1870 SUNSET DR
WHITEHALL PA
18052-4126
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-6383
  • Fax:
Mailing address:
  • Phone: 484-866-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010535
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: