Provider Demographics
NPI:1962150144
Name:GOLD, BONNIE ALYSE (OT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ALYSE
Last Name:GOLD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 CHATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-9491
Mailing Address - Country:US
Mailing Address - Phone:704-473-7119
Mailing Address - Fax:
Practice Address - Street 1:1404 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3406
Practice Address - Country:US
Practice Address - Phone:980-487-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist