Provider Demographics
NPI:1225257843
Name:BONAROTI, HEIDI P (OT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:P
Last Name:BONAROTI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 W PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1322
Mailing Address - Country:US
Mailing Address - Phone:480-510-4219
Mailing Address - Fax:
Practice Address - Street 1:1802 W PARKSIDE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1322
Practice Address - Country:US
Practice Address - Phone:480-510-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791568Medicaid