Individual
JILL MARIE BASIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.O.T.
Contact information
Practice address
9050 COLUMBIA AVE, MUNSTER, IN 46321-2905
(219) 836-0193
(219) 836-0570
Mailing address
9034 COLUMBIA AVE, MUNSTER, IN 46321-2905
(219) 836-0296
(219) 836-0570
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003833A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000484843
ANTHEM
IN
Enumeration date
03/10/2007
Last updated
07/08/2007
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