Provider Demographics
NPI:1700191079
Name:GUNDY, TIMOTHY J (OTR/L)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:GUNDY
Suffix:
Gender:M
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 1:3608 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1725
Mailing Address - Country:US
Mailing Address - Phone:509-758-2896
Mailing Address - Fax:
Practice Address - Street 1:3608 MASTERS DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1725
Practice Address - Country:US
Practice Address - Phone:509-758-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist