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NPI Code Detail

MEDICARE: MRS. GINGER RENE GUSTASON OTR/L

MEDICARE:  MRS. GINGER RENE GUSTASON  OTR/L
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 TherapistOT12044FL

General Provider Information

NPI Number : 1609237437
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GINGER RENE GUSTASON OTR/L
Provider Business Mailing Address
First Line : 586 SANFORD DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-3134
Country : US
Telephone Number : 239-265-8737
Fax Number :
Provider Business Practice Location Address
First Line : 586 SANFORD DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-3134
Country : US
Telephone Number : 239-265-8737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2016
Last Update Date : 03/07/2016

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Directions to “ MRS. GINGER RENE GUSTASON OTR/L” Practice Location

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