Provider Demographics
NPI:1568128551
Name:GUNDERSON, RANDELLE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:RANDELLE
Middle Name:
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:DR
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1179 EXPECTATION CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-8531
Mailing Address - Country:US
Mailing Address - Phone:702-249-9334
Mailing Address - Fax:
Practice Address - Street 1:1179 EXPECTATION CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-8531
Practice Address - Country:US
Practice Address - Phone:702-249-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist