Provider Demographics
NPI:1336585751
Name:COLLEEN A. KUNZ OTRL, PLLC.
Entity type:Organization
Organization Name:COLLEEN A. KUNZ OTRL, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:313-443-0528
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-0945
Mailing Address - Country:US
Mailing Address - Phone:313-443-0528
Mailing Address - Fax:313-908-7270
Practice Address - Street 1:15827 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1120
Practice Address - Country:US
Practice Address - Phone:313-443-0528
Practice Address - Fax:313-908-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty