Provider Demographics
NPI:1730214529
Name:RUSCO, JON G (MS OTR/L)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:G
Last Name:RUSCO
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Gender:M
Credentials:MS OTR/L
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Other - First Name:
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Mailing Address - Street 1:3551 HIGHLAND AVE
Mailing Address - Street 2:HEALTH AND WELLNESS CENTER
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2100
Mailing Address - Country:US
Mailing Address - Phone:630-275-1284
Mailing Address - Fax:630-275-2698
Practice Address - Street 1:3551 HIGHLAND AVE
Practice Address - Street 2:HEALTH AND WELLNESS CENTER
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2100
Practice Address - Country:US
Practice Address - Phone:630-275-1284
Practice Address - Fax:630-275-2698
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL056.003050225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics