Provider Demographics
NPI:1225682149
Name:ZUNDEL, JILL CHRISTINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:ZUNDEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CHRISTINE
Other - Last Name:ZUNDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1148 N WILLOW WIND DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-5074
Mailing Address - Country:US
Mailing Address - Phone:801-633-1238
Mailing Address - Fax:
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7029150-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist