Basic Information
Provider Information
NPI: 1699309831
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BONDS
FirstName: ERYN
MiddleName: VICTORIA
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6397 LEE HWY STE 300
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374214915
CountryCode: US
TelephoneNumber: 4232387217
FaxNumber: 4232383473
Practice Location
Address1: 860 JOHNSON FY RD NE STE 100
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421461
CountryCode: US
TelephoneNumber: 4042525545
FaxNumber: 4042525511
Other Information
ProviderEnumerationDate: 02/26/2020
LastUpdateDate: 02/26/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/26/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT007653GAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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