Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056.010330 | IL |
NPI | 1063985174 |
---|---|
Provider Name | Mr. Adesola O Bello |
First Address | Dolton, IL 60419 |
Second Address | Dolton, IL 60419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 10/01/2019 |