Individual
GRANT A BASKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 W MAIN ST, RIVERTON, WY 82501-3342
(307) 857-7074
(307) 856-6459
Mailing address
PO BOX 2400, ROCK SPRINGS, WY 82902-2400
(307) 362-4336
(307) 362-4339
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR-763
WY
Other
Enumeration date
10/09/2009
Last updated
10/09/2009
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