Provider Demographics
NPI:1679918767
Name:BUNYAN, JOAN P (OTR)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:P
Last Name:BUNYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:P
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0239
Mailing Address - Country:US
Mailing Address - Phone:845-615-1585
Mailing Address - Fax:
Practice Address - Street 1:20 WALNUT ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2260
Practice Address - Country:US
Practice Address - Phone:845-457-5555
Practice Address - Fax:845-457-5556
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist