Provider Demographics
NPI:1427875087
Name:BONYAK, MACKENZIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BONYAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2409
Mailing Address - Country:US
Mailing Address - Phone:607-481-3812
Mailing Address - Fax:
Practice Address - Street 1:2400 KINGSTON CT
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3650
Practice Address - Country:US
Practice Address - Phone:717-755-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist