Provider Demographics
NPI:1376667360
Name:BUNCH, KRISTIE KATHRYN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:KATHRYN
Last Name:BUNCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KRISTIE
Other - Middle Name:KATHRYN
Other - Last Name:CHRANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:804 STATE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4951
Mailing Address - Country:US
Mailing Address - Phone:217-224-1750
Mailing Address - Fax:217-224-0403
Practice Address - Street 1:804 STATE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4951
Practice Address - Country:US
Practice Address - Phone:217-224-1750
Practice Address - Fax:217-224-0403
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006055225X00000X
MO2000175651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILKC79160401POtherEARLY INTERVENTION