Active NPI
Blaine Bunch
- Occupational Therapist
- Waynesboro, MS
National Provider Identifier
1053061259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2524
- Practice address
- 1304 Walnut St
Waynesboro, MS 39367-2232 - Phone
- (601) 735-9025
- NPI assigned
- Mar 28, 2022
- Last updated
- Mar 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2524 | MS | Primary |
Addresses
Primary practice location
1304 Walnut St
Waynesboro, MS 39367-2232
Mailing address
754 Buckatunna Chicora Clara Rd
Waynesboro, MS 39367-7381
Phone (601) 381-1719
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2524 | MS | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1053061259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "754 BUCKATUNNA CHICORA CLARA RD",
"city": "WAYNESBORO",
"state": "MS",
"postal_code": "393677381",
"telephone_number": "601-381-1719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1304 WALNUT ST",
"city": "WAYNESBORO",
"state": "MS",
"postal_code": "393672232",
"telephone_number": "601-735-9025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNCH",
"first_name": "BLAINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-28",
"last_updated": "2022-03-28",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "2524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waynesboro, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.