Healthcare Provider Details

I. General information

NPI: 1770618431
Provider Name (Legal Business Name): PATRICIA LYNN BUNGE HUBER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA LYNN BUNGE

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

15302 40TH AVE W UNIT 1-202
LYNNWOOD WA
98087
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-6742
  • Fax: 808-983-6752
Mailing address:
  • Phone: 808-227-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number660
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: