MEDICARE: SUNNY LYNN DE BAUN

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	4489	AZ

General Provider Information

NPI Number	:	1639400492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNY LYNN DE BAUN

Provider Business Mailing Address
First Line	:	1625 N CIRCLE I RD
Second Line	:
City	:	WILLCOX
State	:	AZ
Zip	:	85643-3163
Country	:	US
Telephone Number	:	520-384-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 N CIRCLE I RD
Second Line	:
City	:	WILLCOX
State	:	AZ
Zip	:	85643-3163
Country	:	US
Telephone Number	:	520-384-2102
Fax Number	:

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

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	06/10/2025

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