Healthcare Provider Details

I. General information

NPI: 1073481529
Provider Name (Legal Business Name): RANDY JAMES WUNSCHE OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 10TH AVE
VERO BEACH FL
32960-5399
US

IV. Provider business mailing address

6390 HIGH POINTE WEST WAY
VERO BEACH FL
32967-5433
US

V. Phone/Fax

Practice location:
  • Phone: 772-633-2719
  • Fax:
Mailing address:
  • Phone: 772-633-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT8999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: