Provider Demographics
NPI:1922167600
Name:WAREHAM, BONNIE G
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:G
Last Name:WAREHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 PENN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1550
Mailing Address - Country:US
Mailing Address - Phone:814-696-6212
Mailing Address - Fax:
Practice Address - Street 1:208 LAKEMONT PARK BLVD
Practice Address - Street 2:EARLY INTERVENTION
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-944-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist