Healthcare Provider Details

I. General information

NPI: 1669772976
Provider Name (Legal Business Name): ROGER BRION KUNDTZ OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY S-117-RCS
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY S-117-RCS
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 206-277-6098
  • Fax: 206-764-2263
Mailing address:
  • Phone: 206-277-6098
  • Fax: 206-764-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT 003546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: