Individual
MR. GEORGE STEPHEN GUSTOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
133 GEORGE ST, NILES, OH 44446-2725
(330) 652-4247
Mailing address
133 GEORGE ST, NILES, OH 44446-2725
(330) 652-4247
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
03634
OH
224Z00000X
Occupational Therapy Assistant
OP007218
PA
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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