Healthcare Provider Details

I. General information

NPI: 1013552082
Provider Name (Legal Business Name): BONNIE BOWMAN SCHLESSELMAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 BIG HORN AVE SHERIDAN MANOR
SHERIDAN WY
82801
US

IV. Provider business mailing address

1851 BIG HORN AVE SHERIDAN MANOR
SHERIDAN WY
82801
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-2109
  • Fax: 307-674-5814
Mailing address:
  • Phone: 307-674-4416
  • Fax: 307-674-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA1254
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: