Provider Demographics
NPI:1598015638
Name:MUNDENAR, DONNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MUNDENAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1526
Mailing Address - Country:US
Mailing Address - Phone:570-457-5315
Mailing Address - Fax:570-457-4719
Practice Address - Street 1:100 LYNWOOD AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2868
Practice Address - Country:US
Practice Address - Phone:570-346-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002100L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist