Individual
JAN E BANQUICIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
429 W LINCOLN RD, KOKOMO, IN 46902-3508
(765) 453-5600
Mailing address
903 GULF SHORE BLVD, KOKOMO, IN 46902-4898
(765) 864-0813
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31004083A
IN
Other
Enumeration date
07/07/2008
Last updated
07/07/2008
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