Individual
DENNIS BASALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
811 COURT ST, JACKSON, CA 95642-2131
(415) 218-6644
Mailing address
818 HAMPTON ST, VACAVILLE, CA 95687-8235
(415) 218-6644
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
110586
TX
225X00000X
Occupational Therapist
Primary
2681
CA
Other
Enumeration date
08/05/2010
Last updated
08/05/2010
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