Healthcare Provider Details

I. General information

NPI: 1316858707
Provider Name (Legal Business Name): ANGELA GUSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34815 W MICHIGAN AVE STE 1
WAYNE MI
48184-1895
US

IV. Provider business mailing address

1790 SANDY CREEK LN
ANN ARBOR MI
48103-8859
US

V. Phone/Fax

Practice location:
  • Phone: 734-219-3190
  • Fax:
Mailing address:
  • Phone: 734-751-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201006736
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: