Individual
MISS KIMBERLY A BONAFEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-5288
Mailing address
3034 NE 49TH AVE, PORTLAND, OR 97213-1845
(503) 228-9461
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1061321
OR
Other
Enumeration date
06/07/2007
Last updated
07/08/2007
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