Provider Demographics
NPI:1801212998
Name:ABDO, BONNIE (COTA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ABDO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5089 RICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14171-9795
Mailing Address - Country:US
Mailing Address - Phone:716-983-9287
Mailing Address - Fax:
Practice Address - Street 1:393 NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-9652
Practice Address - Country:US
Practice Address - Phone:716-592-9331
Practice Address - Fax:716-592-4683
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006094-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist