Individual
KEVIN BOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
180 S 3RD ST BLDG E, SUITE 30, BELLEVILLE, IL 62220-1952
(618) 234-2120
(618) 222-4661
Mailing address
180 S 3RD ST BLDG E, SUITE 30, BELLEVILLE, IL 62220-1952
(618) 234-2120
(618) 222-4661
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056004158
IL
Other
Enumeration date
07/14/2008
Last updated
07/14/2008
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