Provider Demographics
NPI:1316985955
Name:MUSUN, MIRNA DINORA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MIRNA
Middle Name:DINORA
Last Name:MUSUN
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 1:1821 E 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-4025
Mailing Address - Country:US
Mailing Address - Phone:509-475-3275
Mailing Address - Fax:
Practice Address - Street 1:1821 E 35TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-4025
Practice Address - Country:US
Practice Address - Phone:509-475-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist