Provider Demographics
NPI:1528101243
Name:KEATON, BONNIE (OTR)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KEATON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 GRAND CYPRESS CIR W
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2341
Mailing Address - Country:US
Mailing Address - Phone:386-697-6430
Mailing Address - Fax:954-227-5418
Practice Address - Street 1:10168 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3938
Practice Address - Country:US
Practice Address - Phone:954-753-4441
Practice Address - Fax:954-346-8139
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12463225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891745100Medicaid