Healthcare Provider Details

I. General information

NPI: 1629703442
Provider Name (Legal Business Name): CONNOR WUNSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SANTA BARBARA ST
SANTA BARBARA CA
93101-2232
US

IV. Provider business mailing address

3517 129TH ST
URBANDALE IA
50323-2101
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-4338
  • Fax:
Mailing address:
  • Phone: 515-480-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number24936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: