Provider Demographics
NPI:1255699211
Name:GUNZ, MIRIAM JANE (OT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JANE
Last Name:GUNZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 AUSTIN ST APT 5M
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1814
Mailing Address - Country:US
Mailing Address - Phone:917-270-6362
Mailing Address - Fax:
Practice Address - Street 1:8333 AUSTIN ST APT 5M
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1814
Practice Address - Country:US
Practice Address - Phone:917-270-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist