Healthcare Provider Details

I. General information

NPI: 1396564563
Provider Name (Legal Business Name): CHRISTIAN MUSTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W FISHER ST
SALISBURY NC
28144-4116
US

IV. Provider business mailing address

4 FARRWOOD RD
WINDHAM NH
03087-1835
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-2781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3391
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: