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General NPI Number Information
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NPI Number | 1881060879
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Entity Type | Individual
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Provider Name | GIOVANNA MUSTIN
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Gender | Female
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Dates
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Enumeration Date | 08/13/2015
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 151 E MINNEHAHA AVE
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City | CLERMONT
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State | FL
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Zip | 34711-3424
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Country | US
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Telephone | 352-394-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 3674 MAIDENCAIN ST
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City | CLERMONT
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State | FL
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Zip | 34714-5032
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Country | US
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Telephone | 706-877-0535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0TA001953
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA17904
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License Number State | FL
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