KACY MOSES GUSTAFSON

NORTH AUGUSTA, SC
NPI1952494338
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: SC  2572)
Additional Taxonomies224Z00000X Occupational Therapy Assistant
(Licence: GA  OTA000860)
Enumeration Date2006-09-30
Last Update Date2007-07-08
Business Address
-- KACY MOSES GUSTAFSON COTA/L
350 AUSTIN GRAYBILL RD
NORTH AUGUSTA, SC 29860-9251
Phone number: 803-278-4272
Mailing Address
-- KACY MOSES GUSTAFSON COTA/L
2421 CAMELOT DR
AUGUSTA, GA 30904-3381
Phone number: 706-799-3160