Provider Demographics
NPI:1497128482
Name:RUNDEL, WENDY LEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LEE
Last Name:RUNDEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3526
Mailing Address - Country:US
Mailing Address - Phone:541-601-2683
Mailing Address - Fax:
Practice Address - Street 1:1870 HOPE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3526
Practice Address - Country:US
Practice Address - Phone:541-601-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist