Provider Demographics
NPI:1083826242
Name:KUNTZ, REBECCA LYNN (COTAL)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 23RD AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1163
Mailing Address - Country:US
Mailing Address - Phone:406-626-0400
Mailing Address - Fax:
Practice Address - Street 1:4718 23RD AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1163
Practice Address - Country:US
Practice Address - Phone:406-626-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT965224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant