Individual
SAMUEL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16405 NORTHCROSS DR, SUITE G-2, HUNTERSVILLE, NC 28078-5091
(704) 439-3406
Mailing address
16405 NORTHCROSS DR, SUITE G-2, HUNTERSVILLE, NC 28078-5091
(704) 439-3406
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0000000651
TN
Other
Enumeration date
06/19/2009
Last updated
06/19/2009
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