Provider Demographics
NPI:1306589239
Name:BONAVENTURA, ASHLEY DAWN
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DAWN
Last Name:BONAVENTURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HUSKIES WAY
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1257
Mailing Address - Country:US
Mailing Address - Phone:740-942-7800
Mailing Address - Fax:
Practice Address - Street 1:100 HUSKIES WAY
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1257
Practice Address - Country:US
Practice Address - Phone:740-942-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006407224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant