Provider Demographics
NPI:1962546390
Name:STEPHENS, BONNIE L (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:STEPHENS
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 1:2213 RIVER TRAILS CIR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2222
Mailing Address - Country:US
Mailing Address - Phone:916-362-0078
Mailing Address - Fax:916-369-5304
Practice Address - Street 1:5740 WINDMILL WAY
Practice Address - Street 2:SUITE 15
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1379
Practice Address - Country:US
Practice Address - Phone:916-482-7698
Practice Address - Fax:916-482-7798
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist