Basic Information
| Provider Information | |||||||||
| NPI: | 1306152954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVIS | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660011 | ||||||||
| FaxNumber: | 9419570033 | ||||||||
| Practice Location | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660011 | ||||||||
| FaxNumber: | 9419570033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2010 | ||||||||
| LastUpdateDate: | 08/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT13844 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XL0004X | OT13844 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No ID Information.