Provider Demographics
NPI:1477794568
Name:MONDRESS, JOAN (LAC, OTR/L)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MONDRESS
Suffix:
Gender:F
Credentials:LAC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2303
Mailing Address - Country:US
Mailing Address - Phone:267-308-0550
Mailing Address - Fax:267-308-0550
Practice Address - Street 1:109 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2303
Practice Address - Country:US
Practice Address - Phone:267-308-0550
Practice Address - Fax:267-308-0550
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000945171100000X
PAOC000359L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist