| Doctor Name: | BONNIE LORRAINE VAN DE MARK |
| NPI Number: | 1528175163 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OTR/L, CHT |
| License Number: | 101090 |
| Business Practice Address: | 5803 Neal Ave N Oak Park Heights, MN - 550822177 |
| Business Phone Number: | 6514398807 |
| Business Fax Number: | 6514390232 |
| Mailing Address: | 5803 Neal Ave N, OAK PARK HEIGHTS |
| State: | MN |
| Postal Code: | 550822177 |
| Phone Number: | 6514398807 |
| Fax Number: | 6514390232 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 06/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | 101090 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |