Provider Demographics
NPI:1780834978
Name:BONGIORNO, DANA RENEE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RENEE
Last Name:BONGIORNO
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 1:19701 VERNIER RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1467
Mailing Address - Country:US
Mailing Address - Phone:313-884-8920
Mailing Address - Fax:
Practice Address - Street 1:19701 VERNIER RD
Practice Address - Street 2:SUITE 280
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1467
Practice Address - Country:US
Practice Address - Phone:313-884-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI52001005048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist