Provider Demographics
NPI:1598915746
Name:MUNDT, JUDITH LOUISE (OTR-L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LOUISE
Last Name:MUNDT
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 1:26322 TOWNE CENTRE DR
Mailing Address - Street 2:637
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2473
Mailing Address - Country:US
Mailing Address - Phone:949-716-6336
Mailing Address - Fax:
Practice Address - Street 1:26322 TOWNE CENTRE DR
Practice Address - Street 2:637
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2473
Practice Address - Country:US
Practice Address - Phone:949-716-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist