Individual
JOSELITO ESTOQUE ENCABO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
2827 NORTHGATE BLVD, FORT WAYNE, IN 46835-2903
(260) 492-1400
Mailing address
8423 BREMEN WAY, FORT WAYNE, IN 46825-8305
(260) 490-5090
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003538A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1555-656
—
IN
Enumeration date
07/31/2007
Last updated
07/31/2007
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