Provider Demographics
NPI:1518004894
Name:BUNZEL, REYNOLD (OT)
Entity Type:Individual
Prefix:
First Name:REYNOLD
Middle Name:
Last Name:BUNZEL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 CARLISLE AVE
Mailing Address - Street 2:209
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107
Mailing Address - Country:US
Mailing Address - Phone:505-828-0232
Mailing Address - Fax:505-823-1051
Practice Address - Street 1:2308 CARLISLE AVE NE
Practice Address - Street 2:209
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-828-0232
Practice Address - Fax:505-823-1051
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist