Provider Demographics
NPI:1467338335
Name:BONHAM, AMANDA NICOLE (L/COTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:BONHAM
Suffix:
Gender:F
Credentials:L/COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 SAMMY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5716
Mailing Address - Country:US
Mailing Address - Phone:318-547-7778
Mailing Address - Fax:
Practice Address - Street 1:1001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4763
Practice Address - Country:US
Practice Address - Phone:870-425-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A2148225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist