Provider Demographics
NPI:1649523770
Name:HAYHURST, BONNIE (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:HAYHURST
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3050
Mailing Address - Country:US
Mailing Address - Phone:440-289-2004
Mailing Address - Fax:
Practice Address - Street 1:64 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3050
Practice Address - Country:US
Practice Address - Phone:440-289-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07452225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist