Basic Information
| Provider Information | |||||||||
| NPI: | 1003007949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MROCZKOWSKI | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | COTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8917 E PINE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857107951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202966966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2303 N SWAN RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203605860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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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 | 224Z00000X | 1515 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.