Provider Demographics
NPI:1669702353
Name:KUENZIE, JAMIE L (OTR/L)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:KUENZIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ELDON ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1642
Mailing Address - Country:US
Mailing Address - Phone:573-885-4500
Mailing Address - Fax:
Practice Address - Street 1:210 ELDON ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1642
Practice Address - Country:US
Practice Address - Phone:573-885-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist