Individual
JONATHAN GUSTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
95 JOHN MUIR DRIVE, AMHERST, NY 14228
(800) 543-9399
Mailing address
121 HASKINS LN N, HILTON, NY 14468-8957
(585) 766-1991
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010091-1
NY
Other
Enumeration date
07/02/2019
Last updated
07/02/2019
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