Provider Demographics
NPI:1508269960
Name:BONASSO, ABBEY ELAINE
Entity Type:Individual
Prefix:MRS
First Name:ABBEY
Middle Name:ELAINE
Last Name:BONASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ABBEY
Other - Middle Name:ELAINE
Other - Last Name:FISTEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT-BC
Mailing Address - Street 1:19448 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-6884
Mailing Address - Country:US
Mailing Address - Phone:937-477-8076
Mailing Address - Fax:
Practice Address - Street 1:6070 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-5104
Practice Address - Country:US
Practice Address - Phone:937-477-8076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08682225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist