Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 56006138 | IL |
NPI | 1407966856 |
---|---|
Provider Name | Mr. Thomas Gerald Bancsi |
First Address | Michigan City, IN 46360-9377 |
Second Address | Tinley Park, IL 60477-4789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |