Provider Demographics
NPI:1669213716
Name:HAUN, THEORESA BUNCH
Entity type:Individual
Prefix:
First Name:THEORESA
Middle Name:BUNCH
Last Name:HAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5278 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8078
Mailing Address - Country:US
Mailing Address - Phone:912-433-5118
Mailing Address - Fax:
Practice Address - Street 1:5278 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8078
Practice Address - Country:US
Practice Address - Phone:912-433-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS.13651225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist