Provider Demographics
NPI:1669772976
Name:KUNDTZ, ROGER BRION (OTR/L)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:BRION
Last Name:KUNDTZ
Suffix:
Gender:M
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 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:S-117-RCS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-6098
Mailing Address - Fax:206-764-2263
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:S-117-RCS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-6098
Practice Address - Fax:206-764-2263
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 003546225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation