DOMINIC PROSPERO

SOUTH BEND, IN
NPI1851898076
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225X00000X Occupational Therapist
(Licence: IN  31007611A)
Additional Taxonomies225X00000X Occupational Therapist
(Licence: IL  056-012465)
Enumeration Date2018-04-13
Last Update Date2023-10-12
Business Address
DOMINIC PROSPERO
53880 CARMICHAEL DR
SOUTH BEND, IN 46635-1567
Phone number: 574-247-9441
Mailing Address
DOMINIC PROSPERO
3600 W BETHEL AVE
MUNCIE, IN 47304-5407
Phone number: 800-622-6575