Individual
FAITH BASOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
403 MUNICIPAL DR, CARTERVILLE, IL 62918-2042
(855) 608-3560
(618) 956-9349
Mailing address
902 W MAIN ST, WEST FRANKFORT, IL 62896-2210
(618) 937-6483
(618) 937-1440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
224Z00000X
Occupational Therapy Assistant
057003132
IL
Other
Enumeration date
07/20/2016
Last updated
12/03/2021
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