Healthcare Provider Details

I. General information

NPI: 1376851931
Provider Name (Legal Business Name): BRYCE WUNDER OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 PELHAM RD 7M
NEW ROCHELLE NY
10805-1641
US

IV. Provider business mailing address

541 PELHAM RD 7M
NEW ROCHELLE NY
10805-1641
US

V. Phone/Fax

Practice location:
  • Phone: 917-757-0126
  • Fax:
Mailing address:
  • Phone: 917-757-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: