Active NPI
Bianca Antoinette Bonilla, 224Z00000X
- Occupational Therapy Assistant
- Folkston, GA
National Provider Identifier
1821532961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 15458
- Practice address
- 36261 Okefenokee Dr
Folkston, GA 31537-7853 - Phone
- (912) 496-7396
- NPI assigned
- Dec 8, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 15458 | FL | Primary |
Addresses
Primary practice location
36261 Okefenokee Dr
Folkston, GA 31537-7853
Mailing address
2894 West 8TH St.
Jacksonville, FL 32254
Phone (904) 325-8677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15458 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481155200000",
"number": "1821532961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2894 WEST 8TH ST.",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32254",
"telephone_number": "904-325-8677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36261 OKEFENOKEE DR",
"city": "FOLKSTON",
"state": "GA",
"postal_code": "315377853",
"telephone_number": "912-496-7396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONILLA",
"first_name": "BIANCA",
"middle_name": "ANTOINETTE",
"credential": "224Z00000X",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-08",
"last_updated": "2016-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "15458",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Folkston, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.