Organization
BONVITA PEDIATRIC THERAPY AND LACTATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TEDDIE GENTER OTR/L (OCCUPATIONAL THERAPIST)
(562) 417-6068
Entity
Organization
Contact information
Practice address
1610 N COLUMBIA AVE, SEWARD, NE 68434-1111
(402) 523-2128
Mailing address
1610 N COLUMBIA AVE, SEWARD, NE 68434-1111
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
225X00000X
Occupational Therapist
Primary
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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