Provider Demographics
NPI:1306956941
Name:BONZANI, PAUL (OT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BONZANI
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MOULTON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03833-5508
Mailing Address - Country:US
Mailing Address - Phone:561-504-9542
Mailing Address - Fax:
Practice Address - Street 1:75A LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4353
Practice Address - Country:US
Practice Address - Phone:828-281-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11395225X00000X
NC2065225X00000X
NH2231225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2231OtherSTATE LICENSE
NC#2065OtherSTATE LICENSE