Individual
MICHELLE BONANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
84 LAWRENCE HILL RD, WESTON, VT 05161-5602
(802) 289-2930
Mailing address
84 LAWRENCE HILL RD, WESTON, VT 05161-5602
(802) 289-2930
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0720000579
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017185
—
VT
Enumeration date
01/25/2010
Last updated
08/20/2016
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