Provider Demographics
NPI:1881841831
Name:STOEHR-KUNTZ, MARY S (TEACHER)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:STOEHR-KUNTZ
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2947
Mailing Address - Country:US
Mailing Address - Phone:716-652-6588
Mailing Address - Fax:
Practice Address - Street 1:472 SOUTH ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2947
Practice Address - Country:US
Practice Address - Phone:716-652-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY821318981390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY821318981OtherTEACHER