Provider Demographics
NPI:1477093532
Name:KUNISCH, MEG CHRISTINE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:MEG
Middle Name:CHRISTINE
Last Name:KUNISCH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10750 HURON LINE RD
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-9522
Mailing Address - Country:US
Mailing Address - Phone:989-977-0644
Mailing Address - Fax:
Practice Address - Street 1:128 W HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1177
Practice Address - Country:US
Practice Address - Phone:989-269-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist