Individual
KEITH S. MAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
285 BEISER BLVD STE 202, DOVER, DE 19904-7804
(302) 747-5995
(302) 244-0144
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
188453
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188453
LICENSE
AK
Enumeration date
02/23/2022
Last updated
12/22/2023
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