Provider Demographics
NPI:1295491249
Name:BONANNO, ADRIENNE JADE (OTR/L, MS)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:JADE
Last Name:BONANNO
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:MISS
Other - First Name:ADRIENNE
Other - Middle Name:JADE
Other - Last Name:WHELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-8333
Mailing Address - Country:US
Mailing Address - Phone:518-727-8220
Mailing Address - Fax:
Practice Address - Street 1:230 W FULTON ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2720
Practice Address - Country:US
Practice Address - Phone:518-727-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020072225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics