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Individual

MS. BONNIE LOU JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
11325 NE WEIDLER, PORTLAND, OR 97220-2211
(503) 251-3776
(503) 253-1871
Mailing address
1025 NE 113TH AVE, PORTLAND, OR 97220-2211

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1020842
OR

Other

Enumeration date
07/19/2007
Last updated
07/19/2007
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