MEDICARE: MRS. ABBEY ELAINE BONASSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	08682	OH

General Provider Information

NPI Number	:	1508269960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABBEY ELAINE BONASSO

Provider Business Mailing Address
First Line	:	19448 BLUE SPRUCE DR
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44149-6884
Country	:	US
Telephone Number	:	937-477-8076
Fax Number	:

Provider Business Practice Location Address
First Line	:	6070 ROYALTON RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5104
Country	:	US
Telephone Number	:	937-477-8076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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