Provider Demographics
NPI:1093265175
Name:LUNDSTEDT, MELISSA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LUNDSTEDT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 E EDGEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1813
Mailing Address - Country:US
Mailing Address - Phone:203-733-6766
Mailing Address - Fax:
Practice Address - Street 1:8523 E EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1813
Practice Address - Country:US
Practice Address - Phone:203-733-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist