Individual
KELLEIGH GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
850 TOWBIN AVE, LAKEWOOD, NJ 08701-5928
(732) 987-3829
Mailing address
515 E SENECA ST, MANLIUS, NY 13104-1918
(517) 899-9777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
025551
NY
225X00000X
Occupational Therapist
Primary
OT200001205
DC
Other
Enumeration date
06/07/2021
Last updated
06/23/2021
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