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Individual

MARTHA HOUSTON BONNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
2092 AYRSLEY TOWN BLVD, CHARLOTTE, NC 28273-4037
(704) 577-4094
Mailing address
2321 COMMONWEALTH AVE, CHARLOTTE, NC 28205-5129
(334) 462-8043

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11000
NC

Other

Enumeration date
01/20/2020
Last updated
01/20/2020
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