Provider Demographics
NPI:1063606408
Name:NEILL BUNDY, GINGER R (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:R
Last Name:NEILL BUNDY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:R
Other - Last Name:BUNDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1201 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64469-4028
Mailing Address - Country:US
Mailing Address - Phone:816-449-2281
Mailing Address - Fax:816-449-2281
Practice Address - Street 1:1201 S POLK ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64469-4028
Practice Address - Country:US
Practice Address - Phone:816-449-2281
Practice Address - Fax:816-449-2281
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025510224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006025510OtherDIV. OF PROF. REG.