MEDICARE: REYNOLD BUNZEL OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1733	NM

General Provider Information

NPI Number	:	1518004894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNOLD BUNZEL OT

Provider Business Mailing Address
First Line	:	2308 CARLISLE AVE
Second Line	:	209
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107
Country	:	US
Telephone Number	:	505-828-0232
Fax Number	:	505-823-1051

Provider Business Practice Location Address
First Line	:	2308 CARLISLE AVE NE
Second Line	:	209
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107
Country	:	US
Telephone Number	:	505-828-0232
Fax Number	:	505-823-1051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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