Basic Information
| Provider Information | |||||||||
| NPI: | 1528356185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONVILLAIN | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | CALHOUN | ||||||||
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| OtherLastName: | CALHOUN | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | MARGARET | ||||||||
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| OtherCredential: | DPT, MOT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1326 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707912743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256548208 | ||||||||
| FaxNumber: | 2256544642 | ||||||||
| Practice Location | |||||||||
| Address1: | 1326 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707912743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256548208 | ||||||||
| FaxNumber: | 2256544642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 08/18/2014 | ||||||||
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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 | 08009 | LA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | OTT.200443 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.