Provider Demographics
NPI:1861857955
Name:BONUS, WILLIAM DIBELLO (COTA/L)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DIBELLO
Last Name:BONUS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7756 HARLEY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3662
Mailing Address - Country:US
Mailing Address - Phone:440-552-6451
Mailing Address - Fax:
Practice Address - Street 1:13900 BENNETT RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3808
Practice Address - Country:US
Practice Address - Phone:440-237-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.05509224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification