Provider Demographics
NPI:1629638309
Name:BASSO, JONATHAN (MSOT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:BASSO
Suffix:
Gender:M
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ALEXANDER LOOP
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6524
Mailing Address - Country:US
Mailing Address - Phone:541-345-6199
Mailing Address - Fax:
Practice Address - Street 1:425 ALEXANDER LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6524
Practice Address - Country:US
Practice Address - Phone:541-345-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005952225X00000X
OR415849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist