Individual
HAZEL NALYN BASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2237 ENGLE RD, FORT WAYNE, IN 46809-1404
(260) 747-2353
Mailing address
1800 N WABASH RD STE 200, MARION, IN 46952-1300
(765) 651-3229
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001575A
IN
Other
Enumeration date
12/26/2008
Last updated
12/26/2008
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