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NPI Code Detail

MEDICARE: ROBERT LAWRENCE GUSTIN

MEDICARE: ROBERT LAWRENCE GUSTIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201003825MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194227025
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT LAWRENCE GUSTIN
Provider Business Mailing Address
First Line : 3941 LONG MEADOW LN
Second Line :
City : LAKE ORION
State : MI
Zip : 48359-1465
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3500 SOUTH BLVD W
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-3973
Country : US
Telephone Number : 248-852-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2018
Last Update Date : 03/07/2018

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