Provider Demographics
NPI:1043014731
Name:CASTRUITA, JESSICA (CTRS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CASTRUITA
Suffix:
Gender:
Credentials:CTRS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:38257 MOUND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3466
Mailing Address - Country:US
Mailing Address - Phone:586-722-7524
Mailing Address - Fax:
Practice Address - Street 1:38257 MOUND RD STE 200
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3466
Practice Address - Country:US
Practice Address - Phone:586-722-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI62941225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist