Provider Demographics
NPI:1992397053
Name:MUNDO, CATHERINE NICOLE TETZLAFF (OT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:NICOLE TETZLAFF
Last Name:MUNDO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:NICOLE
Other - Last Name:TETZLAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:35 CONGRESS ST STE 211
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5529
Mailing Address - Country:US
Mailing Address - Phone:978-825-8800
Mailing Address - Fax:978-740-4720
Practice Address - Street 1:104 ENDICOTT ST STE LL02
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3688
Practice Address - Country:US
Practice Address - Phone:617-724-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist