Provider Demographics
NPI:1972614311
Name:BONOANNO, PAMELA JEAN (OTR)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:BONOANNO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2935
Mailing Address - Country:US
Mailing Address - Phone:608-244-3299
Mailing Address - Fax:
Practice Address - Street 1:1323 CRESTON PARK DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1126
Practice Address - Country:US
Practice Address - Phone:608-756-9440
Practice Address - Fax:608-756-9455
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist