Healthcare Provider Details

I. General information

NPI: 1598679235
Provider Name (Legal Business Name): MARGARET BODNOVICH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 SE 256TH ST
KENT WA
98030-6643
US

IV. Provider business mailing address

1502 FAWCETT AVE APT 1611
TACOMA WA
98402-5509
US

V. Phone/Fax

Practice location:
  • Phone: 253-373-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.OT.70153335.PORTA
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: