Provider Demographics
NPI:1144396466
Name:LUNDE, JENNIFER E (OTRL)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:LUNDE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 ARIEL ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2203
Mailing Address - Country:US
Mailing Address - Phone:651-773-0354
Mailing Address - Fax:651-773-0371
Practice Address - Street 1:2399 ARIEL ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2203
Practice Address - Country:US
Practice Address - Phone:651-773-0354
Practice Address - Fax:651-773-0371
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102945225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics