Basic Information
| Provider Information | |||||||||
| NPI: | 1679918767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUNYAN | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | OTR | ||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | CAREY | ||||||||
| OtherFirstName: | JOAN | ||||||||
| OtherMiddleName: | P | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 239 | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109240239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456151585 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20 WALNUT ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125492260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454575555 | ||||||||
| FaxNumber: | 8454575556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2013 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 010679 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.