Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | U1-0001183 | DE |
N | 225XH1200X | Occupational Therapist - Hand | 46TR00208700 | NJ |
NPI | 1154540037 |
---|---|
Provider Name | Mr. Joseph R. Basante |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Middletown, DE 19709-5805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 12/12/2014 |