Individual
MR. MARK ANTHONY ABEL BASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 351-4926
Mailing address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 351-4926
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.008374
IL
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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