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Individual

DUSTIN DAVID MASK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
COTA/L

Contact information

Practice address
1333 W GRAND RIVER AVE, HOWELL, MI 48843-1980
(517) 548-1900
Mailing address
1333 W GRAND RIVER AVE, HOWELL, MI 48843-1980

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202009868
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5202009868
MI
Enumeration date
11/02/2022
Last updated
11/02/2022
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