Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056-003537 | IL |
Y | 225XH1200X | Occupational Therapist - Hand | 056-003537 | IL |
NPI | 1033495528 |
---|---|
Provider Name | Mr. Brian Patrick Bonner |
First Address | Palos Hills, IL 60465-1971 |
Second Address | Palos Hills, IL 60465-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2011 |
Last Update Date | 07/05/2013 |