Individual
DOMINIC PROSPERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
(800) 622-6575
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056-012465
IL
225X00000X
Occupational Therapist
Primary
31007611A
IN
Other
Enumeration date
04/13/2018
Last updated
10/12/2023
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