Provider Demographics
NPI:1326791724
Name:BONADONNA, JOHN PAUL (OTD)
Entity Type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:
Last Name:BONADONNA
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SUMNER ST UNIT 52
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-4974
Mailing Address - Country:US
Mailing Address - Phone:734-680-7211
Mailing Address - Fax:
Practice Address - Street 1:1167 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4346
Practice Address - Country:US
Practice Address - Phone:508-686-1155
Practice Address - Fax:617-250-8243
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist