Provider Demographics
NPI:1871879668
Name:KUNDRAT, EILEEN (OTR/L)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:KUNDRAT
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 1:2355 E STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4800
Mailing Address - Country:US
Mailing Address - Phone:734-747-8080
Mailing Address - Fax:734-662-6799
Practice Address - Street 1:2355 E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4800
Practice Address - Country:US
Practice Address - Phone:734-747-8080
Practice Address - Fax:734-662-6799
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002747225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist