Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2015008256 | MO |
NPI | 1003386046 |
---|---|
Provider Name | Tammy L Bunger |
First Address | Saint Louis, MO 63125-4111 |
Second Address | Webster Groves, MO 63119-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2018 |
Last Update Date | 03/12/2018 |