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General NPI Number Information
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NPI Number | 1457869307
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Entity Type | Individual
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Provider Name | JAIME RACHELLE MORTIMER BONAR OTR/L, RBT
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Gender | Female
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 1300 LOCUST ST STE C
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City | HARRISONVILLE
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State | MO
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Zip | 64701-1366
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Country | US
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Telephone | 417-448-9766
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Fax | 816-265-1828
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Provider Business Mailing Address
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Address Line | 7217 RAYTOWN RD
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City | RAYTOWN
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State | MO
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Zip | 64133-6648
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Country | US
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Telephone | 816-863-9964
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2020006444
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-16-15377
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License Number State | MO
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