Individual
MR. JASPER S BANZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
1313 DUNBAR AVE, DUNBAR, WV 25064-2920
(304) 654-6892
Mailing address
P.O. BOX 398, 5585 MADISON CREEK RD., SALT ROCK, WV 25559
(304) 654-6892
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1092
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1092
OCCUPATIONAL THERAPY LIC
WV
01
—
KY-R2967
OCCUPATIONAL THERAPY LIC
KY
Enumeration date
04/02/2007
Last updated
09/09/2013
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