Basic Information
| Provider Information | |||||||||
| NPI: | 1316108525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BICHKOFF | ||||||||
| FirstName: | BONNIE | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | OT/PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 944 PATRICIA WAY | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949032326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154463817 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1550 SILVEIRA PKWY | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949034879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154463817 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15721 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 6602 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.