Provider Demographics
NPI:1538539119
Name:KUNTZ, JASON (COTA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KUNTZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 23RD AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1133
Mailing Address - Country:US
Mailing Address - Phone:406-728-9162
Mailing Address - Fax:406-721-1620
Practice Address - Street 1:4718 23RD AVE STE 500
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1133
Practice Address - Country:US
Practice Address - Phone:406-728-9162
Practice Address - Fax:406-721-1620
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2756224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant