Provider Demographics
NPI:1720421340
Name:GUSTIN, CAROLYN MARIE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MARIE
Last Name:GUSTIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:GUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:5801 ALLENTOWN ROAD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746
Mailing Address - Country:US
Mailing Address - Phone:301-238-4788
Mailing Address - Fax:301-298-5442
Practice Address - Street 1:5801 ALLENTOWN ROAD
Practice Address - Street 2:SUITE 410
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746
Practice Address - Country:US
Practice Address - Phone:301-238-4788
Practice Address - Fax:301-298-5442
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC100000251224Z00000X
FLOTA 13076224Z00000X
MDA02011224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant