Provider Demographics
NPI:1760841324
Name:BUNTYLO, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BUNTYLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:PEREPICICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:17141 136TH PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7045
Mailing Address - Country:US
Mailing Address - Phone:206-370-0270
Mailing Address - Fax:
Practice Address - Street 1:17141 136TH PL SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7045
Practice Address - Country:US
Practice Address - Phone:206-370-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALR60561993227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered