Individual
BIANCA ANTOINETTE BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
224Z00000X
Contact information
Practice address
36261 OKEFENOKEE DR, FOLKSTON, GA 31537-7853
(912) 496-7396
Mailing address
2894 WEST 8TH ST., JACKSONVILLE, FL 32254
(904) 325-8677
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
15458
FL
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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