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General NPI Number Information
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NPI Number | 1366079584
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Entity Type | Individual
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Provider Name | NICOLE MARIE BONNIER C.O.T.A.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 215 ANNIE ST
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City | ORLANDO
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State | FL
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Zip | 32806-1207
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Country | US
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Telephone | 407-841-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ROLLING FERN PL
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City | PALM COAST
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State | FL
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Zip | 32164-8915
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Country | US
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Telephone | 321-223-3091
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA12154
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License Number State | FL
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