Healthcare Provider Details

I. General information

NPI: 1730293267
Provider Name (Legal Business Name): DARREN GUSTITUS OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26750 PROVIDENCE PAKRWAY SUITE 220
NOVI MI
48374
US

IV. Provider business mailing address

701 ROSE DR
ANN ARBOR MI
48103-2102
US

V. Phone/Fax

Practice location:
  • Phone: 248-596-0412
  • Fax: 248-596-0418
Mailing address:
  • Phone: 734-395-9466
  • Fax: 888-421-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004144
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: