Provider Demographics
NPI:1619084902
Name:LUNDEN, WANDA L (OTR)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:L
Last Name:LUNDEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 WHITMAN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8749
Mailing Address - Country:US
Mailing Address - Phone:321-557-2562
Mailing Address - Fax:321-327-2102
Practice Address - Street 1:1490 WHITMAN DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8749
Practice Address - Country:US
Practice Address - Phone:321-557-2562
Practice Address - Fax:321-327-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist