Healthcare Provider Details

I. General information

NPI: 1740113521
Provider Name (Legal Business Name): MICHELLE RUST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MOUNT PLEASANT AVE
IPSWICH MA
01938-2156
US

IV. Provider business mailing address

4 MOUNT PLEASANT AVE
IPSWICH MA
01938-2156
US

V. Phone/Fax

Practice location:
  • Phone: 302-690-1966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3993
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: