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NPI Code Detail

MEDICARE: MRS. BONNY MARIE BRAY O.T.R/L

MEDICARE:  MRS. BONNY MARIE BRAY  O.T.R/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT0742MS

General Provider Information

NPI Number : 1073993754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BONNY MARIE BRAY O.T.R/L
Provider Business Mailing Address
First Line : 400 S CHESTNUT ST
Second Line :
City : ABERDEEN
State : MS
Zip : 39730-3335
Country : US
Telephone Number : 662-369-8200
Fax Number : 662-369-8754
Provider Business Practice Location Address
First Line : 400 S CHESTNUT ST
Second Line :
City : ABERDEEN
State : MS
Zip : 39730-3335
Country : US
Telephone Number : 662-369-8200
Fax Number : 662-369-8754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2015
Last Update Date : 06/08/2015

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Directions to “ MRS. BONNY MARIE BRAY O.T.R/L” Practice Location

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