Individual
MICHELLE M BONAVOLONTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056-000708
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01185607
RR MEDICARE
IL
Enumeration date
05/26/2006
Last updated
06/23/2014
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