Healthcare Provider Details

I. General information

NPI: 1558785766
Provider Name (Legal Business Name): GAVIN C CARTER C.T.R.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9286 NORMANDY LN
YPSILANTI MI
48197-9284
US

IV. Provider business mailing address

9286 NORMANDY LN
YPSILANTI MI
48197-9284
US

V. Phone/Fax

Practice location:
  • Phone: 734-436-1207
  • Fax:
Mailing address:
  • Phone: 734-436-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: