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General NPI Number Information
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NPI Number | 1083981708
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Entity Type | Individual
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Provider Name | BONNIE JEAN QUAY OT
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 180 NORTH ST
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City | AUBURN
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State | NY
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Zip | 13021-1811
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Country | US
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Telephone | 315-255-3623
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Fax | 315-255-0852
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | UNION SPRINGS
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State | NY
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Zip | 13160-0069
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Country | US
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Telephone | 315-255-3623
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Fax | 315-255-0852
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 012906
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License Number State | NY
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