Individual
THERESE MAE JOLO BANTASAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6103 BARDU AVE, SPRINGFIELD, VA 22152-1802
(847) 271-2017
Mailing address
6103 BARDU AVE, SPRINGFIELD, VA 22152-1802
(847) 271-2017
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005106
VA
Other
Enumeration date
04/29/2015
Last updated
04/29/2015
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