Provider Demographics
NPI:1497056576
Name:BUNN, DEIRDRE (OTR)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:STE. 308
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5229
Mailing Address - Country:US
Mailing Address - Phone:907-563-8318
Mailing Address - Fax:907-563-3472
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:STE. 308
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5229
Practice Address - Country:US
Practice Address - Phone:907-563-8318
Practice Address - Fax:907-563-3472
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist